Membership Form

PEOPLE’S ACTION FOR COMMUNITY

MOVEMENT AGAINST POVERTY, INC.
(PACMP)

Mr Mrs Ms

Last Name:_____________________________________________________________
First Name_____________________________________________________________
Middle Name___________________________________________________________
Date of Birth:______________________ Place of Birth:_________________________
Religion:_________________________ Gender:_______________________________
Status:__________________________Occupation:____________________________

Address:_______________________________________________________________
______________________________________________________________________
______________________________________________________________________

E-mail: ________________________________Mobile No: (__)__________________

Complete Address (i.e your University/Organization/Company):

______________________________________________________________________
______________________________________________________________________
______________________________________________________________________

Date of Registration:_____________________

I agree that all personal information written above are true and correct. I understand
that membership is not valid until approve by Board of Directors.

________________________ _________________________
(Signature over Printed Name) Date