APO Pledge Program Form No.

5
Revised: 02-07-18
Alpha Phi Omega
Philippines Incorporated

(Chapter)

(College/ University)

(Section) (Administrative Region)

Date: _____________________

MANDATORY PLEDGE REGISTRATION

TO : THE COMMITTEE ON MEMBERSHIP

THRU : THE NATIONAL VICE PRESIDENT FOR THE FRATERNITY / SORORITY AFFAIRS

In compliance with Article III, Section 3 of our 2017 Bylaws, which states that, “No
applicant shall be eligible for membership unless he has first been previously registered in the
records of its Commission on Membership as a pledge and has duly paid the dues and
assessments incident thereto,” here under are our Pledges for the current academic term:

NAME OF PLEDGE START OF COMMENTS/ACTIONS

PLEDGESHIP TAKEN
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.

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 18.
19.
20.
21.
22.
23.
24.
25.
Note: Please cross out above unused portions.

Furthermore, we reaffirm our adherence to Republic Act No. 8049, “An Act ‘Regulating
Hazing’ and Other Forms of Initiation Rites in Fraternities, Sororities, and Organizations and
providing penalties therefore,” in our Chapter.

(Signature over Printed Name and ID Number) (Signature over Printed Name and ID Number)
GRAND CHANCELLOR/ FACULTY ADVISER
GRAND LADY CHANCELLOR

(Signature over Printed Name and ID Number)

SECTION CHAIR FOR COLLEGIATE

NOTED BY:

(Signature over Printed Name and ID Number) (Signature over Printed Name and ID Number)
REGIONAL DIRECTOR FOR COLLEGIATE REGIONAL DIRECTOR

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