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Jpia Membership Application Form: (Surname) (First Name) (Middle Name)

The document is a membership application form for the JPIA organization. It requests information such as name, address, contact details, awards received, and group preference. It also includes short answer questions about expectations from JPIA, events to attend, and suggestions for improvement. The applicant signs to agree to the terms of membership.

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Ky Dulz
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61 views2 pages

Jpia Membership Application Form: (Surname) (First Name) (Middle Name)

The document is a membership application form for the JPIA organization. It requests information such as name, address, contact details, awards received, and group preference. It also includes short answer questions about expectations from JPIA, events to attend, and suggestions for improvement. The applicant signs to agree to the terms of membership.

Uploaded by

Ky Dulz
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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JPIA MEMBERSHIP APPLICATION FORM

Local Chapter: Course: ___________________ Year Level: _____ Section:


__________

1st year 4th year 5th year JPIA No.:_____N/A_________

Name: ___________________________________________________________
(Surname) (First Name) (Middle Name)
Current Address: ____________________________________________________
Permanent Address: _________________________________________________
E-mail Address: ________________________ Mobile No.: __________________
Birth date (mm/dd/yy): __________ Age: _____ Sex: ___ Nationality:_________
Person to contact in case of emergency
Name: _______________________Relationship: ____________________
Contact No.: ___________________

Most significant individual award/s (high school and college)

Institution/ Organization/ Person who Name of the award /


Date received
conferred the award / recognition recognition

SELECT

GROUP / TEAM THAT YOU WANT TO BECOME PART OF

JPIA Quizzers’ Pool JPIAn Artists JPIA Tutorials Guild

1. What do you expect from JPIA this federation year?

____________________________________________________________________

____________________________________________________________________

2. What event/s are you looking forward to attend to?

____________________________________________________________________

___________________________________________________________________

3. What can you suggest for JPIA to improve its events / activities for its members?

____________________________________________________________________

___________________________________________________________________

I, hereby, state that the above information are true and correct, that I possess all the qualifications of
being a member of NFJPIA, NFJPIA-R3 and Tarlac State University - JPIA, I will not violate any
rules set for the organization and that I dedicate myself into fulfilling the mission, vision, goals and
objectives of NFJPIA, NFJPIA-R3 and TSU-JPIA.

_____________________________
Signature over printed name

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