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    Individual Membership Form Sample

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    Individual Membership Form Sample

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    AM
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    Individual-Membership-Form-Sample

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    Individual Membership Form Sample

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    AM

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    of 1

    MANUEL S.

    ENVERGA UNIVERSITY FOUNDATION Document Code: OSA-OSO-F-SOMF


    An Autonomous University Document Title: Student Organization Membership Form
    Page No: 1 of 1
    LUCENA CITY Revision No.: 2
    OFFICE OF STUDENT AFFAIRS Effectivity Date: March 2014
    OFFICE OF STUDENT ORGANIZATION Prepared by: Office of Student Organization
    Reviewed by: QMR
    QUALITY FORM Approved by: President

    STUDENT ORGANIZATION: JUNIOR PHILIPPINE INSTITUTE OF ACCOUNTANTS

    Name: GAILE DOMINIQUE C. PALAYAN Nickname: GAILE


    Birthdate: MARCH 11, 1998 Age: 20 Sex: FEMALE
    Permanent Address: TUAZON SUBD., CITY OF TAYABAS
    Secondary/City Address: ______________N/A______________
    Contact Details: (Mobile) 0947343829
    (Email Address) [email protected]
    Course: BACHELOR OF SCIENCE IN ACCOUNTANCY Year: 4TH

    PARENT’S CONSENT

    I, Mr./Ms./Mrs. CORNELIO A. PALAYAN (parent/guardian) allow my son/daughter to


    join in the student organization. I understand that participation on this organization is
    voluntary.

    Likewise, I understand that the organization will ensure the safety and security of its
    members. As a parent/guardian, I voluntarily waive any claim against the school, adviser or
    authorities in charge, for any untoward incidents which may happen in the activities of the
    organization, after all precautionary measures have been taken by persons in charge.

    CORNELIO A. PALAYAN___ ____________ _____________


    Printed name of Parent/Guardian Signature Date Signed

    Contact Details: (Mobile) 09473437199 (Home Numbers) N/A (Email Address) N/A

    CERTIFICATION OF GOOD MORAL CHARACTER

    This is to certify that GAILE DOMINQUE C. PALAYAN is a bonafide 4TH year student of
    the College of BUSINESS AND ACCOUNTANCY, Enverga University. We can vouch for the
    student’s good moral character.

    This further certifies that the student is qualified to join in the student organization.

    JUSTINIANO L. SANTOS MARIA LUCILA M. PEDIGLORIA


    Adviser Adviser

    CATHERINE D. LIMJUCO
    Acting Dean

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