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Republic of the Philippines Republic of the Philippines

EASTERN VISAYAS STATE UNIVERSITY EASTERN VISAYAS STATE UNIVERSITY


Tacloban City Tacloban City

PHILIPPINE INSTITUTE OF CIVIL ENGINEERS PHILIPPINE INSTITUTE OF CIVIL ENGINEERS


EVSU Student Chapter EVSU Student Chapter

MEMBERSHIP FORM MEMBERSHIP FORM

I, ____________________________________________, voluntarily join PHILIPPINE I, ____________________________________________, voluntarily join PHILIPPINE


INSTITUTE OF CIVIL ENGINEERS – EVSU Student Chapter, Tacloban INSTITUTE OF CIVIL ENGINEERS – EVSU Student Chapter, Tacloban City
City on ____________________________________. on ____________________________________.

1. Name: _____________________________________________________________________ 1. Name: _____________________________________________________________________


(Last Name) (Given Name) (Middle Name) (Last Name) (Given Name) (Middle Name)
2. Age: _____ Date of Birth: _________________ Place of Birth: ________________ 2. Age: _____ Date of Birth: _________________ Place of Birth: ________________
3. Civil Status: _______________________ Course, Year & Section : ____________ 3. Civil Status: _______________________ Course, Year & Section : ____________
4. Citizenship: _______________________ 4. Citizenship: _______________________
5. Home Address: ___________________________________________________________ 5. Home Address: ___________________________________________________________
6. The reason(s) why I want to be part of the PICE-EVSU SC: 6. The reason(s) why I want to be part of the PICE-EVSU SC:
______________________________________________________________________________________ __________________________________________________________________________________
____________________________________________________________________ ________________________________________________________________________

I am eligible to be a member of Philippine Institute of Civil Engineers I am eligible to be a member of Philippine Institute of Civil Engineers
– EVSU Student Chapter, and will maintain true faith and allegiance – EVSU Student Chapter, and will maintain true faith and allegiance
thereto; I will obey the laws, legal orders and decrees promulgated by the thereto; I will obey the laws, legal orders and decrees promulgated by the
duly constituted authorities and this obligation imposed by my oath is duly constituted authorities and this obligation imposed by my oath is
assumed voluntarily, without mental reservation for purpose of evasion; assumed voluntarily, without mental reservation for purpose of evasion;
and the facts stated herein are to be the best of my knowledge. and the facts stated herein are to be the best of my knowledge.

______________________________________ ______________________________________
Signature of Applicant Signature of Applicant
Endorsed by:
Endorsed by:
____________________________________________________
_________________________________________________________ Chapter President
Chapter President
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________ Chapter Advisers
Chapter Advisers

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