19 ALPHA KAPPA RHO 73

INTERNATIONAL HUMANITARIAN SERVICE

FRATERNITY AND SORORITY
DELTA OMICRON CHAPTER

MEMBER INFORMATION SHEET

Application No.: ____________

Year: ____________________

PERSONAL PROFILE:

Name : ________________________________ Date Baptized: ________________________________

Codename : ________________________________ Date Survived: ________________________________
Batch Name : ________________________________ CP No. : ________________________________
Batch Mates : ________________________________ Sex : ________________________________
Home Address : ________________________________ Citizenship : ________________________________
Birthday : ________________________________ Religion : ________________________________
Birth Place : ________________________________ Height : ________________________________
Civil Status : ________________________________ Weight : ________________________________
Contact Person : ________________________________Address:________________________ CP No.: ________________

ACADEMIC BACKGROUND:

Elementary : ________________________________ Date Graduated: ________________________________

Secondary : ________________________________ Date Graduated: ________________________________
Tertiary : ________________________________ Date Graduated: ________________________________
Course : ________________________________ Curriculum Year: ________________________________

ORGANIZATIONAL AFFILIATIONS:

Civic : ________________________________
Academic : ________________________________
Political : ________________________________

I DECLARE under the penalties of perjury that this form has made good faith, verified by me in the best of my
knowledge and beliefs are true and correct.

I DECLARE FURTHER that I had clearly read, agreed to constitutional and by laws of the organization.

________________________________________
SIGNATURE

____________________________________ ____________________________________
GRAND SKEPTRON MASTER INITIATOR