Doc No.

: PBSAI Form 01
Date : 2021 August
MEMBERSHIP APPLICATION FORM Revision: 01
Individual Created by:
Mafe Pastorpide/Girlie Sarmiento

Applicant Name: DR. JOEY U. RIVAMONTE Nickname: JOEY

Gender:  Male  Female Date of Birth: SEPTEMBER 18, 1981

 Prefer not to indicate
Mailing Address: CHED RO7 NATIONAL Occupation/Designation:
GOVERNMENT CENTER, SUDLON LAHUG, CEBU
CITY
EDUCATION SUPERVISOR - II

Telephone/Mobile Numbers: 09433515616/ Email Address: jurivamonte@ched.gov.ph

09359804696

Company/Organization Name: COMMISSION ON Business Address: NATIONAL GOVERNENT CENTER, SUDLON

HIGHER EDUCATION – REGIONAL OFFICE 7 LAHUG, CEBUC ITY

"In submitting this form, I agree to my details being used Involvement in the Bamboo Industry (check all applicable items)
for the purposes of Communication for the organizations’
activities and programs. The information will only be Nursery Operations Bamboo Plantations
accessed by the organization secretariat and membership
committee members. I understand that my data will be Bamboo Processing Wholesaler/Trader
held securely and will not be distributed to third parties. I
have a right to request for changes and I understand that Agri/Eco Tourism Researcher/Academe
when this information is no longer required for this Bamboo Store Owner Importer
purpose, PBSAI procedure will be followed to dispose of
my data." Exporter Others __________
Student

DR. JOEY U. RIVAMONTE 07/11/22

Signature Over Printed Name/Date

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