Professional Documents
Culture Documents
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\plain\pard\sl-169 \li0 \ri2246 \fi729 \expndtw3 \b \f10 \fs15 \cf74 City
Government of Tayabas
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\pard\sl-177 \li0 \ri2179 \fi902 \expndtw3 \b \f10 \fs15 \cf74 Office of the City
Mayor
\plain\par
\pard\sl-288 \li0 \ri1520 \expndtw2 \b \f10 \fs15 \cf74 MOBILE HEALTH AND MEDICAL
EMERGENCY
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\pard\sl-177 \li0 \ri2281 \fi763 \expndtw2 \b \f10 \fs15 \cf74 RESPONSE TEAM
(MHMERT)
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\sect\sectd\sbknone\cols6\colno1\colw2855\colsr134\colno2\colw1217\colsr169\colno3\
colw1008\colsr3893\colno4\colw1507\colsr134\colno5\colw1217\colsr169\colno6\
colw2711
\plain\sl-163\fs16\par\sl-240\fs24\par\pard\pard\sl-358 \li1347 \ri0 \expndtw5 \f10
\fs32 \cf183 Tayabas
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\column
\plain\pard\sl-1168 \li0 \ri0 \expndtw23 \f10 \fs97 \cf183 xl
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\plain\sl-153\fs15\par\sl-240\fs24\par\pard\pard\sl-358 \li0 \ri0 \expndtw-30 \
f10 \fs32 \cf183 CLUB
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\plain\sl-124\fs12\par\sl-240\fs24\par\pard\pard\sl-358 \li0 \ri0 \expndtw5 \f10 \
fs32 \cf183 Tayabas
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\plain\pard\sl-1130 \li0 \ri0 \expndtw23 \f10 \fs97 \cf183 xl
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\plain\sl-115\fs11\par\sl-240\fs24\par\pard\pard\sl-358 \li0 \ri1702 \expndtw-30 \
f10 \fs32 \cf183 CLUB
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\sect\sectd\sbknone\cols2\colno1\colw6269\colsr2505\colno2\colw6244
\plain\pard\sl-291 \li843 \ri1742 \fi1891 \expndtw-17 \b \f10 \fs24 \cf183 (XTRA
LOVED)
\plain\par
\pard\sl-246 \li843 \ri0 \expndtw1 \f10 \fs20 Samahan ng mga Tayabasing may\b \
cf183 X\b0 \cf0 tra Ki\b \cf183 l\b0 \cf0 o sa timbang
\plain\par
\pard\sl-571 \li843 \ri511 \fi571 \expndtw-33 \b \f10 \fs30 \cf183 MEMBERSHIP
APPLICATION FORM
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\plain\pard\sl-291 \li0 \ri2478 \fi1891 \expndtw-17 \b \f10 \fs24 \cf183 (XTRA
LOVED)
\plain\par
\pard\sl-246 \li0 \ri736 \expndtw1 \f10 \fs20 Samahan ng mga Tayabasing may\b \
cf183 X\b0 \cf0 tra Ki\b \cf183 l\b0 \cf0 o sa timbang
\plain\par
\pard\sl-571 \li0 \ri1248 \fi571 \expndtw-33 \b \f10 \fs30 \cf183 MEMBERSHIP
APPLICATION FORM
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\sect\sectd\sbknone\cols15\colno1\colw106\colsr0\colno2\colw457\colsr0\colno3\
colw553\colsr0\colno4\colw165\colsr1\colno5\colw424\colsr0\colno6\colw471\colsr45\
colno7\colw497\colsr1822\colno8\colw631\colsr2767\colno9\colw458\colsr-2\colno10\
colw447\colsr3\colno11\colw466\colsr41\colno12\colw660\colsr5\colno13\colw492\
colsr0\colno14\colw139\colsr1817\colno15\colw2542
\plain\sl-172\fs17\par\sl-240\fs24\par\par\par\pard\pard\sl-192 \li7 \ri0 \expndtw0
\b \f10 \fs15 o
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\plain\sl-300\fs30\par\sl-240\fs24\par\par\pard\pard\sl-280 \li0 \ri0 \expndtw-9 \b
\f10 \fs15 verwe
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\column
\plain\sl-165\fs17\par\sl-240\fs24\par\par\pard\pard\sl-303 \li0 \ri0 \expndtw-4 \b
\f10 \fs15 ight/ob
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\column
\plain\sl-116\fs12\par\sl-240\fs24\par\par\pard\pard\sl-216 \li0 \ri0 \expndtw-12 \
b \f10 \fs15 es
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\plain\sl-260\fs26\par\sl-240\fs24\par\pard\pard\sl-271 \li0 \ri0 \expndtw-8 \b \
f10 \fs15 e\cf185 to h
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\plain\sl-143\fs14\par\sl-240\fs24\par\pard\pard\sl-286 \li0 \ri0 \expndtw-6 \b \
f10 \fs15 \cf185 ealthy
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\column
\plain\sl-239\fs24\par\pard\pard\sl-303 \li0 \ri0 \expndtw-9 \b \f10 \fs15 \cf185
weight
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\plain\sl-133\fs13\par\sl-240\fs24\par\par\par\par\par\pard\pard\sl-259 \li0 \ri0 \
expndtw-20 \f10 \fs25 photo
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\column
\plain\sl-292\fs29\par\sl-240\fs24\par\par\pard\pard\sl-275 \li0 \ri0 \expndtw-10 \
b \f10 \fs15 overw
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\plain\sl-169\fs17\par\sl-240\fs24\par\par\pard\pard\sl-285 \li0 \ri0 \expndtw-4 \b
\f10 \fs15 eight/
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\plain\sl-301\fs30\par\sl-240\fs24\par\pard\pard\sl-283 \li0 \ri0 \expndtw-9 \b \
f10 \fs15 obese
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\plain\sl-129\fs13\par\sl-240\fs24\par\pard\pard\sl-332 \li0 \ri0 \expndtw-6 \b \
f10 \fs15 \cf185 to hea
\plain\expndtw-12 \b \f10 \fs15 \cf185 lth
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\column
\plain\sl-258\fs26\par\pard\pard\sl-279 \li0 \ri0 \expndtw-7 \b \f10 \fs15 \cf185 y
weig
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\plain\sl-201\fs20\par\pard\pard\sl-215 \li0 \ri0 \expndtw-12 \b \f10 \fs15 \cf185
ht
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\plain\sl-94\fs9\par\sl-240\fs24\par\par\par\par\par\pard\pard\sl-259 \li0 \
ri1719 \expndtw-20 \f10 \fs25 photo
\par
\sect\sectd\sbknone\cols2\colno1\colw6970\colsr1003\colno2\colw7046
\plain\sl-278\fs28\par\sl-240\fs24\par\par\par\par\par\par\pard\pard\sl-202 \li41 \
ri1622 \fi4518 \expndtw-21 \i \f10 \fs20 (Name)
\plain\par
\sl-181\fs18\par\sl-240\fs24\par\pard\pard\sl-202 \li41 \ri0 \expndtw-15 \f10 \fs20
Address: ______________________________________________________________
\par
\column
\plain\sl-239\fs24\par\sl-240\fs24\par\par\par\par\par\par\pard\pard\sl-202 \li0 \
ri1728 \fi4518 \expndtw-21 \i \f10 \fs20 (Name)
\plain\par
\sl-186\fs19\par\sl-240\fs24\par\pard\pard\sl-202 \li0 \ri105 \expndtw-15 \f10 \
fs20 Address: ______________________________________________________________
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\sect\sectd\sbknone\cols4\colno1\colw3894\colsr1241\colno2\colw1904\colsr932\
colno3\colw3853\colsr1241\colno4\colw1952
\plain\sl-211\fs21\par\pard\pard\sl-202 \li41 \ri0 \expndtw-14 \f10 \fs20 Contact
No.: ____________________________
\plain\par
\sl-205\fs21\par\pard\pard\sl-202 \li41 \ri0 \expndtw-13 \f10 \fs20 Birthdate:
______________________________
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\column
\plain\sl-211\fs21\par\pard\pard\sl-202 \li0 \ri26 \expndtw-18 \f10 \fs20 Sex:
_______________
\plain\par
\sl-205\fs21\par\pard\pard\sl-202 \li0 \ri0 \expndtw-17 \f10 \fs20 Age:
_______________
\par
\column
\plain\pard\sl-379 \li0 \ri0 \expndtw-14 \f10 \fs20 Contact No.:
____________________________
\plain\par
\sl-205\fs21\par\pard\pard\sl-202 \li0 \ri0 \expndtw-13 \f10 \fs20 Birthdate:
______________________________
\par
\column
\plain\pard\sl-379 \li0 \ri68 \expndtw-18 \f10 \fs20 Sex: _______________
\plain\par
\sl-205\fs21\par\pard\pard\sl-202 \li0 \ri42 \expndtw-17 \f10 \fs20 Age:
_______________
\par
\sect\sectd\sbknone\plain\sl-177\fs18\par\pard\pard\sl-235 \li41 \ri21 \expndtw-
15 \f10 \fs20 Height: ____________
\plain\tx2308 \tab \expndtw-14 \f10 \fs20 Weight: ______________
\plain\tx5135 \tab \expndtw-16 \f10 \fs20 BMI: _______________
\plain\tx7973 \tab \expndtw-15 \f10 \fs20 Height: ____________
\plain\tx10239 \tab \expndtw-14 \f10 \fs20 Weight: ______________
\plain\tx13040 \tab \expndtw-16 \f10 \fs20 BMI: _______________
\par
\sect\sectd\sbknone\cols2\colno1\colw7074\colsr865\colno2\colw7080
\plain\sl-85\fs9\par\sl-240\fs24\par\pard\pard\sl-196 \li7 \ri5 \expndtw-9 \f10 \
fs15 Ako, aplikante ng Tayabas XL Club, ay nagbibigay ng pahintulot sa Pamahalaan
ng Lungsod ng Tayabas, Office
\plain\expndtw-6 \f10 \fs15 of the City Mayor, Mobile Health and Medical Emergency
Response Team (MHMERT) staff & employee sa
\plain\par
\pard\sl-192 \li7 \ri7 \expndtw-7 \f10 \fs15 pag-koleksyon; paggamit ng ayon sa
batas, at pagsisiwalat ng aking personal na impormasyon na maaaring
\plain\par
\pard\sl-196 \li7 \ri446 \expndtw-8 \f10 \fs15 kasama ang pangalan, address,
contact information, petsa ng kapanganakan at iba pang mga detalye.
\plain\par
\sl-192\fs19\par\pard\pard\sl-196 \li7 \ri0 \expndtw-6 \f10 \fs15 Ang pahintulot na
ito ay nagbibigay-daan sa Pamahalaan ng Lungsod ng Tayabas, Office of the City
Mayor,
\plain\expndtw-9 \f10 \fs15 Mobile Health at Medical Emergency Response Team
(MHMERT) na sumunod sa RA 10173 Data Privacy Act
\plain\expndtw-12 \f10 \fs15 of 2012.
\plain\par
\sl-229\fs23\par\pard\pard\sl-158 \li7 \ri2017 \expndtw-7 \f10 \fs15 Pinatutunayan
ko na ang impormasyong ibinigay sa itaas ay totoo at tama.
\plain\par
\sl-197\fs20\par\sl-240\fs24\par\pard\pard\sl-245 \li7 \ri503 \fi629 \expndtw-15 \
f10 \fs20 ___________________________________________________________
\plain\par
\pard\sl-245 \li7 \ri978 \fi1162 \expndtw-11 \f10 \fs20 Signature over printed
name/ Pirma sa ibabaw ng pangalan
\par
\column
\plain\sl-287\fs29\par\pard\pard\sl-196 \li0 \ri17 \expndtw-9 \f10 \fs15 Ako,
aplikante ng Tayabas XL Club, ay nagbibigay ng pahintulot sa Pamahalaan ng Lungsod
ng Tayabas, Office
\plain\expndtw-6 \f10 \fs15 of the City Mayor, Mobile Health and Medical Emergency
Response Team (MHMERT) staff & employee sa
\plain\par
\pard\sl-191 \li0 \ri19 \expndtw-7 \f10 \fs15 pag-koleksyon; paggamit ng ayon sa
batas, at pagsisiwalat ng aking personal na impormasyon na maaaring
\plain\par
\pard\sl-196 \li0 \ri458 \expndtw-8 \f10 \fs15 kasama ang pangalan, address,
contact information, petsa ng kapanganakan at iba pang mga detalye.
\plain\par
\sl-192\fs19\par\pard\pard\sl-196 \li0 \ri12 \expndtw-6 \f10 \fs15 Ang pahintulot
na ito ay nagbibigay-daan sa Pamahalaan ng Lungsod ng Tayabas, Office of the City
Mayor,
\plain\expndtw-9 \f10 \fs15 Mobile Health at Medical Emergency Response Team
(MHMERT) na sumunod sa RA 10173 Data Privacy Act
\plain\expndtw-12 \f10 \fs15 of 2012.
\plain\par
\sl-229\fs23\par\pard\pard\sl-158 \li0 \ri2029 \expndtw-7 \f10 \fs15 Pinatutunayan
ko na ang impormasyong ibinigay sa itaas ay totoo at tama.
\plain\par
\sl-197\fs20\par\sl-240\fs24\par\pard\pard\sl-245 \li0 \ri511 \fi633 \expndtw-15 \
f10 \fs20 ___________________________________________________________
\plain\par
\pard\sl-245 \li0 \ri985 \fi1166 \expndtw-11 \f10 \fs20 Signature over printed
name/ Pirma sa ibabaw ng pangalan
\par
\sect\sectd\sbknone}