Professional Documents
Culture Documents
1.1. Affiliation Form
1.1. Affiliation Form
Name of School:
Name of School Chapter Organization:
Name of College Dean:
Name of Department Head:
School Address: ____________________________________________________________
____________________________________________________________
(Street, City, Province, Zip Code)
Telephone Numbers:
Fax Numbers:
Email Address:
IIEE- CSC @ 27
Secretary
Name: ___________________________________________________
Contact number: ____________________
Email: ____________________________
Birthday: __________________________
Signature: _________________________
Treasurer
Name: ___________________________________________________
Contact number: ____________________
Email: ____________________________
Birthday: __________________________
Signature: _________________________
Auditor
Name: ___________________________________________________
Contact number: ____________________
Email: ____________________________
Birthday: __________________________
Signature: _________________________
Public Relation Officer
Name: ___________________________________________________
Contact number: ____________________
Email: ____________________________
Birthday: __________________________
Signature: _________________________
Chapter Representative
Name: ___________________________________________________
Contact number: ____________________
Email: ____________________________
Birthday: __________________________
Signature: _________________________
Chapter Representative
Name: ___________________________________________________
Contact number: ____________________
Email: ____________________________
Birthday: __________________________
Signature: _________________________
IIEE- CSC @ 27
Members
Name: ___________________________________________________
Contact number: ____________________
Email: ____________________________
Birthday: __________________________
Signature: _________________________
Name: ___________________________________________________
Contact number: ____________________
Email: ____________________________
Birthday: __________________________
Signature: _________________________
Name: ___________________________________________________
Contact number: ____________________
Email: ____________________________
Birthday: __________________________
Signature: _________________________
Name: ___________________________________________________
Contact number: ____________________
Email: ____________________________
Birthday: __________________________
Signature: _________________________
Name: ___________________________________________________
Contact number: ____________________
Email: ____________________________
Birthday: __________________________
Signature: _________________________
Name: ___________________________________________________
Contact number: ____________________
Email: ____________________________
Birthday: __________________________
Signature: _________________________
Name: ___________________________________________________
Contact number: ____________________
Email: ____________________________
Birthday: __________________________
Signature: _________________________
Name: ___________________________________________________
Contact number: ____________________
Email: ____________________________
Birthday: __________________________
Signature: _________________________
IIEE- CSC @ 27
Name: ___________________________________________________
Contact number: ____________________
Email: ____________________________
Birthday: __________________________
Signature: _________________________
Name: ___________________________________________________
Contact number: ____________________
Email: ____________________________
Birthday: __________________________
Signature: _________________________
Name: ___________________________________________________
Contact number: ____________________
Email: ____________________________
Birthday: __________________________
Signature: _________________________
Name: ___________________________________________________
Contact number: ____________________
Email: ____________________________
Birthday: __________________________
Signature: _________________________
Name: ___________________________________________________
Contact number: ____________________
Email: ____________________________
Birthday: __________________________
Signature: _________________________
Name: ___________________________________________________
Contact number: ____________________
Email: ____________________________
Birthday: __________________________
Signature: _________________________
Name: ___________________________________________________
Contact number: ____________________
Email: ____________________________
Birthday: __________________________
Signature: _________________________
Name: ___________________________________________________
Contact number: ____________________
Email: ____________________________
Birthday: __________________________
Signature: _________________________
IIEE- CSC @ 27
School: _____________________________________________
Region: ________
Total Members: ____________
List:
1.__________________________________
2.__________________________________
3.__________________________________
4.__________________________________
5.__________________________________
6.__________________________________
7.__________________________________
8.__________________________________
9.__________________________________
10 _________________________________
11 _________________________________
12 _________________________________
13 _________________________________
14 _________________________________
15 _________________________________
16 _________________________________
17 _________________________________
18 _________________________________
19 _________________________________
20 _________________________________
21 _________________________________
22 _________________________________
23 _________________________________
24 _________________________________
25 _________________________________
26 _________________________________
27 _________________________________
28 _________________________________
29 _________________________________
30 _________________________________
31 _________________________________
32 _________________________________
33 _________________________________
34 _________________________________
35 _________________________________
36 _________________________________
37 _________________________________
38 _________________________________
39 _________________________________
40 _________________________________
41 _________________________________
42 _________________________________
43 _________________________________
44 _________________________________
45 _________________________________
46 _________________________________
47 _________________________________
48._________________________________
49._________________________________
50._________________________________
51._________________________________
52._________________________________
53._________________________________
54._________________________________
55._________________________________
56._________________________________
57._________________________________
58._________________________________
59._________________________________
60._________________________________
61._________________________________
62._________________________________
63._________________________________
64._________________________________
65._________________________________
66._________________________________
67._________________________________
68._________________________________
69._________________________________
70._________________________________
71._________________________________
72._________________________________
73._________________________________
74._________________________________
75._________________________________
76._________________________________
77._________________________________
78._________________________________
79._________________________________
80._________________________________
81._________________________________
82._________________________________
83._________________________________
84._________________________________
85._________________________________
86._________________________________
87._________________________________
88._________________________________
89._________________________________
90._________________________________
91._________________________________
92._________________________________
93._________________________________
94._________________________________
95._________________________________
96._________________________________
97._________________________________
98._________________________________
99.________________________________
100 ________________________________
IIEE- CSC @ 27
101 ________________________________
102 ________________________________
103.________________________________
104.________________________________
105.________________________________
106.________________________________
107.________________________________
108.________________________________
109.________________________________
110.________________________________
111.________________________________
112.________________________________
113.________________________________
114.________________________________
115.________________________________
116.________________________________
117.________________________________
118.________________________________
119.________________________________
120.________________________________
121.________________________________
122.________________________________
123.________________________________
124.________________________________
125.________________________________
126.________________________________
127 _______________________________
128 _______________________________
129.________________________________
130.________________________________
131.________________________________
132.________________________________
133.________________________________
134._______________________________
135.________________________________
136.________________________________
137.________________________________
138.________________________________
139.________________________________
140.________________________________
141.________________________________
142.________________________________
143.________________________________
144.________________________________
145.________________________________
146.________________________________
147.________________________________
148.________________________________
149.________________________________
150.________________________________
IIEE- CSC @ 27
CHECKLIST
1
10
11
Accomplished forms with 2pcs. 1x1 ID picture. One pasted on hard copy and
one spare.
12
13
14
15
16
IIEE- CSC @ 27