THE FRATERNAL ORDER OF Eagles

(Philippine Eagles)
First Philippine Born Fraternal Socio-Civic Organization
“Service Through Strong Brotherhood”

PHILIPPINE EAGLES INSTITUTE OF LEADERSHIP

Manila Matikas Gideons Eagles Club
MEMBERSHIP APPLICATION FORM
PERSONAL INFORMATION:
NAME
GILBERT BERT DELACRUZ LAPUZ
FIRST NAME (NICKNAME) MIDDLE LAST NAME
CIVIL STATUS
PLACE OF BIRTH SAN PEDRO, STA.ANA PAMPANGA
DATE OF BIRTH SEPTEMBER 14,1984 SINGLE MARRIED

HEIGHT 5’10” WEIGHT 92 kgs. SEPARATED WIDOW/ER

CITIZENSHIP Filipino RELIGION Catholic BLOOD TYPE O

ADDRESS
1465 ULI ULI ST. BARANGAY 639 SAN MIGUEL, MANILA NCR
STREET NO. BARANGAY MUNICIPALITY/CITY PROVINCE ZIP CODE

TELEPHONE NO. CELLPHONE NO. 09167347280 EMAIL aysa30lapuz@gmail.com

EMPLOYMENT / PROFESSION:
NAME OF OFFICE POLYTECH CONS.DEVELOPMENT ADDRESS CUBAO, QUEZON CITY
LINE OF BUSINESS CORPORATION
TITLE AND POSITION ELECTRICIAN TEL. NO. FAX NO.

LIST OF LEGAL DEPENDENTS:

NAME DATE OF BIRTH AGE
SPOUSE NAME AYSA GENEVIERE O. LAPUZ AUGUST 30,1973 48
NAME 1. JED CHRISTIAN O. LAPUZ NOVEMBER 28.2009 12
OF 2. KASSANDRA O. LAPUZ AUGUST 12,2015 7
C 3.
H
I
L 4.
D
R 5.
E
N 6.

EDUCATIONAL ATTAINMENT:
SAN JUAN SAN PEDRO ELEMENTARY SCHOOL
ELEMENTARY DATE GRADUATED 1996
PAMPANGA
HIGH SCHOOL SAN ISIDRO HS PAMPANGA DATE GRADUATED 2000
COLLEGE DON HONORIO VOCATIONAL SCHOOL DATE GRADUATED 2002
COURSE ELECTRICIAN
HOBBIES
SPECIAL SKILLS DRIVING
SPONSOR: (Regular Member of the Club)
NAME DATE SIGNATURE

Eagle
APPLICANT’S SIGNATURE
ENDORSED BY:

Eagle HERBERT S. DAYON Eagle JERICO S. DE GUZMAN

REGIONAL GOVERNOR, NCR - XXII EY 2022
CONCURRED BY: APPROVED BY:

Eagle ALEXANDER T. ALAG Eagle NELSON ALONTO SARAPUDDIN

EXECUTIVE PEIL DIRECTOR EY 2021 - 2022 NATIONAL PRESIDENT EY 2021 - 2022