19 ALPHA KAPPA RHO 73

INTERNATIONAL HUMANITARIAN SERVICE FRATERNITY SORORITY

SAN BARTOLOME CHAPTER

Application Form

Information Sheet:

Name: ___________________________________________ Nickname: _________

Family Name First Name Middle Name:

Address: ________________________________________________ Age: _______

Height: _________________ Weight:__________ Date of Birth: _______________

Month/Day/year
Father’s Name: ______________________ Mother’s Name: ____________________

Name of School: ______________________________________________________

Contact #: _________________ Other organization involved with: ________________

That I, ______________________________ voluntary Submit myself under this organization,

I’ am fully aware of the initiation rites that I have to undergo and it’s consequence as well – informed
neophyte, thus I have pledge that nobody shall be held responsible if anything happens to me.

I’ am also aware of the sum of thirty pesos (PhP 30.00) that I have to pay as an entrance fee.

Signed on __________________________
Month Day Year

___________________
Applicant Signature GRAND SKEPTRON

Initiation rites held on __________________ at _______________________

alias ____________________ Batch No: ____________ Batch Name: ___________

MASTER OF INITIATION