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CSP Membership Application Form

This document is a membership application form for an individual applying to join the Computing Society of the Philippines (CSP). It requests basic contact information such as name, address, email and phone number. It also asks for payment details and includes a declaration that the information provided is true and complete. Membership is valid for 12 months and entitles the member to services from the CSP based in Quezon City, Philippines.

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415 views1 page

CSP Membership Application Form

This document is a membership application form for an individual applying to join the Computing Society of the Philippines (CSP). It requests basic contact information such as name, address, email and phone number. It also asks for payment details and includes a declaration that the information provided is true and complete. Membership is valid for 12 months and entitles the member to services from the CSP based in Quezon City, Philippines.

Uploaded by

Anonymous PcPkRpAKD5
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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CSP MEMBERSHIP APPLICATION FORM (INDIVIDUAL)

Submit this form to [email protected] or fax to 920-2036. Official Receipt may be obtained through the Office Secretariat at the UPITDC Office.

*supply required information


MEMBERSHIP

*Membership Status:  New  Renew


*Year of membership:

PERSONAL INFORMATION

*Name:
Last Name First Name Middle Name

*Address:

No. Street Barangay / Municipality Postal Code City / Province

*E-mail address: Cellphone No.


*Telephone No.

**FOR INSTITUTIONAL MEMBERSHIP

Position:
Institution / Company:
Address:
E-mail address
Telephone No: Fax No.

*MODE OF PAYMENT

 Cash  Check  Bank Deposit


Amount: Amount: Amount:
Received by: Acct No. Acct No.
Check No. Date Deposited:
BDO Branch:

I hereby declare that the information supplied in this application is true and complete. I acknowledge
the provision that incorrect information may result in cancellation of membership.

Signature Date

Membership is valid for 12 months form the date of purchase.


**Institutional membership includes free 2 individual memberships.

Computing Society of the Philippines (CSP)


University of the Philippines Information Technology Development Center (UPITDC)
2/F Vidal A. Tan Hall, Quirino Ave. cor. Velasquez St.
University of the Philippines, Diliman, Quezon City 1101 Philippines Tel: (02) 920.2080
Fax: (02) 920.2036 website: http://www.csp.org.ph E-mail: [email protected]
CSP-MAF JUNE 2012

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