Student Number: __2022-13647___

Receipt Number: ___2005911476095_

CENTRO ESCOLAR UNIVERSITY

Manila
Student Affairs Office
Organizations Membership Application Form 2021

__________________CEU – RED CROSS YOUTH______________________

(Name of Organization the Student Wishes to Join)

GCash Account Number of the Organization: 0341012533001 CEU Red Cross Youth

Applicant’s Name ___Alegre Jewel Joy Guiruela_____Nickname__Ligaya_____________

Surname First M.I.

Course__Doctor of Optometry___ Year__First______ Section_OD-NSTEM______

E-Mail Address___jewellealeguiruela26@gmail.com_____________ Gender: Male _____ Female__ ✔️ ___

Nationality____Filipino______________ Fb Account Name:_________Jewel

Alegre_________________________ Cellphone number _____09452173209_______________________

CONFIDENTIALITY NOTICE: The information in the form is intended for the use of the
organization/s it is addressed to. It may contain personal data, or information that is confidential or
privileged, which are protected from unauthorized use or disclosure by law. If you are not the intended
recipient, please be aware that printing, copying, dissemination, distribution, disclosure, forwarding of, or
acting in reliance upon the information contained in this communication is strictly prohibited.

(Return the lower portion to the student as their receipt)

-- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ------- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
This serves as your R E C E I P T upon receiving the complete payment.
To be accomplished by the Membership Committee
Action taken:
Approved: Disapproved:

Remarks: _____________________________________________________________________________________

Membership Fee paid: ____________ Receipt Number: ________________

This is to certify that ___________________________ is a member of this organization

___________________. He/She has all the rights to enjoy the privileges extended to any member and/or officer of
the aforementioned organization.
 ________________________________________________
Printed Name of Adviser and/or Authorized Person

Revised, August 15, 2021