Piie Membership Form
1
Home Address: Home Home: Fax: [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ] Fellowship Amendements Certification / Technical Ways and Means National Congress Professional Development Membership (Industry / Academe) Student Chapter Publications PIIE Membership Chairman Signature of Applicant / Representative P0,750.00 P0,500.00 Cash O.R. # Amount Promotion Mode: Bank Name: Check # Check Preferred Committee: P1,200.00 Institution [ ] Requirements: 1. Resume of Applicant / Representative - individual member rate / professor whose institution is a member P3,500.00 Amount E-mail Address: Fax No.: Programs (GMMs) - individual member rate / student within one year after graduation P h o n e N u m b e r : Office: A d d r e s s : Phone Nos.: [ ] [ ] Individual / Industry P1,000.00 Academe - individual member rate for those whose institution is a member 2. Annual Membership Fees P1,500.00 P1,500.00 Student Chapter [ ] 1. Type of Membership (Please check applicable status) E m p l o y e r : A d d r e s s : For Institutional Membership (Allowed to have one Alternate member) E - m a i l A d d r e s s : Cellphone No.: Date of Birth: Nickname: Name of Alternate Representative: Work P o s i t i o n : Title / Department / Position: City / State / Province: Preferred Mailing Address for PIIE Correspondence (check one) Name: Mr. / Ms. Last First Middle Initial Website: http://www.piie.org PHILIPPINE INSTITUTE OF INDUSTRIAL ENGINEERS G/F Pacific Coast Plaza, Coastal Road, Parañaque City 1701 Tel. No. (632) 879-8381 Telefax no. (632) 879-8103 Email: [email protected] M E M B E R S H I P A P P L I C A T I O N Please Affix Latest 1" x 1" photo
Transcript of Piie Membership Form
Home Address:Home
Home: Fax:
[ ] [ ][ ] [ ][ ] [ ][ ] [ ][ ] [ ][ ]
FellowshipAmendements
Certification / TechnicalWays and MeansNational Congress
Professional Development
Membership (Industry / Academe)Student ChapterPublications
PIIE Membership ChairmanSignature of Applicant / Representative
P0,750.00P0,500.00
Cash O.R. #Amount
Promotion
Mode: Bank Name: Check #Check
Preferred Committee:
P1,200.00
Institution [ ]
Requirements:1. Resume of Applicant / Representative
- individual member rate / professor whose institution is a member
P3,500.00
Amount
E-mail Address:
Fax No.:
Programs (GMMs)
- individual member rate / student within one year after graduation
P h o n e N u m b e r : Office:
A d d r e s s :Phone Nos.:
[ ][ ]
Individual / IndustryP1,000.00Academe
- individual member rate for those whose institution is a member
2. Annual Membership Fees
P1,500.00
P1,500.00
Student Chapter [ ]
1. Type of Membership (Please check applicable status)
E m p l o y e r :A d d r e s s :
For Institutional Membership (Allowed to have one Alternate member)E - m a i l A d d r e s s : Cellphone No.:
Date of Birth: Nickname:
Name of Alternate Representative:
Work
P o s i t i o n :
Title / Department / Position:
City / State / Province:
Preferred Mailing Address for PIIE Correspondence (check one)
Name: Mr. / Ms.Last First Middle Initial
Website: http://www.piie.org
PHILIPPINE INSTITUTE OF INDUSTRIAL ENGINEERSG/F Pacific Coast Plaza, Coastal Road, Parañaque City 1701
Tel. No. (632) 879-8381 Telefax no. (632) 879-8103 Email: [email protected]
M E M B E R S H I P A P P L I C A T I O N
PleaseAffix
Latest1" x 1" photo
