PHILIPPINE INSTITUTE OF ENVIRONMENTAL PLANNERS

G/F School of Urban and Regional Planning Bldg.

University of the Philippines, Diliman, Quezon City, Philippines
TeleFax: 920-9705 │Email: secretariat@piep.org.ph

MEMBERSHIP FORM  Old

Member
Section I: CONTACT DETAILS  New
Member
Full Name

Residential Address

Office Address

Fax / Telephone Number

Mobile Number

Email

Date of Birth (mm/dd/yy) PRC license No. Year Obtained

Section II: EDUCATION

School Degree / Certificate obtained Date obtained

Other Professional Certification

Section III: EMPLOYMENT: Work experience for the most recent 3 years

Employer / Project Position Period of Employment

Section IV: INDUSTRY: Check all that apply

 Academe  Government: National Agency

 Private Practice / Firm  Government: Local

 Consultancy  Development Work (including I/NGOs)

 Others: please specify
__________________________________________________________________________________
Section V: FIELDS/ AREAS OF EXPERTISE: Check all that apply

 Land Use Planning  Economics

 Infrastructure / Utilities Planning  Statistics

 Transportation Planning  Law / Legal Administration

 Institutional Planning  GIS / Mapping

 Environment / Natural Resources Planning  Architecture

 Heritage Planning  Engineering

 Tourism Planning  Sociology / Social Sciences

 Estate Planning  Climate Change / Disaster Risk Reduction

 Others: please specify
__________________________________________________________________________________
 Section VI: TRAININGS / SEMINARS

Title of Training/Seminar Year

Section VII: MEMBERSHIP IN OTHER ORGANIZATIONS

Organization and Position Year

Please check if you agree with the following statements:

 I agree and certify that to the best of my knowledge that the information I provided is truthful and accurate.

I agree and give my consent to PIEP to include the information I provided herewith in its directory to be published
and circulated with the general membership

 I hereby express my interest to be a member of the Philippine Institute of Environmental Planners. Enclosed is the
amount of ___________ to serve as payment for membership fees.

Name and Signature of Applicant Date

PIEP MEMBERSHIP COMMITTEE’S ACTION (Please check):

Date Evaluated _________________

 Accepted as ( regular / associate / affiliate ) member

 Action deferred due to
_________________________________________________________________________
 Decline due to
_______________________________________________________________________________

REMARKS:
______________________________________________________________________________________

MEMBERSHIP COMMITTEE:
Chairman __________________
Members __________________