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Philippine Association of Agriculturists, Inc. (PAA) : Personal Information

This document is a membership form for the Philippine Association of Agriculturists, Inc. (PAA). It requests personal information such as name, contact details, educational background, and current employment. It also includes fields for payment information and a data privacy consent. The form allows applicants to select between regular or associate membership and indicates a regional chapter if applicable.

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Kent Alpay
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2K views1 page

Philippine Association of Agriculturists, Inc. (PAA) : Personal Information

This document is a membership form for the Philippine Association of Agriculturists, Inc. (PAA). It requests personal information such as name, contact details, educational background, and current employment. It also includes fields for payment information and a data privacy consent. The form allows applicants to select between regular or associate membership and indicates a regional chapter if applicable.

Uploaded by

Kent Alpay
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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Revised 06February2020

Philippine Association of Agriculturists, Inc. (PAA)


3rd Floor, DOST-PCAARRD Innovation and Technology Center
Jamboree Road, Brgy. Timugan, Los Baños, Laguna, 4030 Philippines
Telephone Numbers: 0933 302 1179; 0933 394 9597; 0917 545 3770
Email: paa.philippines@gmail.com | Web: www.paa.org.ph

MEMBERSHIP FORM

Date of Membership: _
Regional Chapter (if any): _________________
Type of membership (pls check):
☐ Regular ☐ Associate

PERSONAL INFORMATION:

Name: _________________ ___________________ ___________________


Last Name First Name Middle Name

Date of Birth: ____________ Age: ____ Gender: □ Female □ Male


Civil Status: ___________ Nationality: _________________________________
Home Address: _______________________________________________________
Telephone Number: ________________ Mobile Number: ___________________
Email Address: ____________________ Fax Number (if any): _______________

PRC Registration No: ____________ Date of Registration: _______________________

CURRENT EMPLOYMENT:

Organization/Institution: _________________________________________________
Position/Designation: ___________________________________________________
Office Address: ________________________________________________________
Telephone Number: ________________ Mobile Number: ___________________
Email Address: ____________________ Fax Number (if any): ________________

HIGHEST EDUCATIONAL ATTAINMENT

Degree: ______________________ Field of Specialization: ____________________


Name of University: ______________________________ Year Graduated: _________

Membership fee paid under OR# _________ dated _________________


Annual due (3-year) paid under OR# ________ dated _______________

DATA PRIVACY CONSENT:

By signing/filling-out this Information/Membership Form, I acknowledge and consent the processing of personal information/data provided
herein, subject to compliance with applicable laws and regulations.  I further consent to the sharing and processing by the Philippine
Association of Agriculturists, Inc. (PAA) and its Regional Chapters my personal information/data, for purposes relating to my PAA
membership.

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