TFOE-Form

2 NATIONAL I.D. APPLICATION FORM

NEW MEMBERSHIP / / RENEWAL

NAME (LASTNAME, FIRSTNAME, MIDDLE NAME) CLUB/ REG POSITION

VILLAGARCIA, FORTUNATO, CALOSA DKMEC/ CLUB PRES

HOME ADDRESS:

B-11 L-19 BLOOMFIELDS SUBDIVISION, BRGY PASONG PUTIK, NOVALICHES, QC

MOBILE NO. HEIGHT: WEIGHT: BLOOD RELIGION:
(FEET) (KGS) TYPE:
09560753160 5’7” 75 “O” ROMAN CATHOLIC
CONTACT PERSON IN CASE OF EMERGENCY: CONTACT NUMBER:

FERLINA VILLAGARCIA 09063975678

BIRTH DATE: BIRTH PLACE:

AUG 28, 1970 BONGABON, NUEVA ECIJA

CLUB PRESIDENT: (required) SIGNATURE: DATE: REGION:

Jan 10, 2024 STRXXXVI

Eagle Fortunato C. Villagarcia

REGIONAL MEMBERSHIP:(required) SIGNATURE: DATE: REMARKS:

COMMITTEE FOR MEMBERSHIP: SIGNATURE: DATE: REMARKS:

(LUZON, VISAYAS & MINDANAO)

Eagle ________________________

CLUB AFFILIATED: (TO BE FILLED UP BY APPLICANT)

REGIONAL GOVERNOR EY 2024: (TO BE FILLED UP BY THE GOVERNOR) MEMBER CONTROL NO.

Eagle GILMAR P. PARADO

APPLICANT’S SIGNATURE
REG. GOVERNOR SIGNATURE LATEST 2 X 2 PICTURE

INSTRUCTION:

ENDORSED BY: CHAIRMAN MEMBERSHIP 1.0 RENEWAL NOT REQUIRED ENDORSEMENT FROM COMMITTEE FOR
(Luzon, Visayas and Mindanao) MEMBERSHIP

2.0 NEW MEMBERHIP APPLICATION SHALL REQUIRES ENDORSEMENT

Eagle ________________________ FROM COMMITTEE ON MEMBERSHIP
NAME & SIGNATURE ABOVE
 NATIONAL I.D. APPLICATION FORM
NEW MEMBERSHIP / / RENEWAL

NAME (LASTNAME, FIRSTNAME, MIDDLE NAME) CLUB/ REG POSITION

MANUEL, EDDIE LEON DE DKMEC/ CLUB BOD

HOME ADDRESS:

BLK 139 LOT 12 RAJAH SUMAKWEL ST. UPPER BICUTAN, TAGUIG CITY
MOBILE NO. HEIGHT: WEIGHT: BLOOD RELIGION:
(FEET) (KGS) TYPE:
09165907607 5’6” 80 “A” ROMAN CATHOLIC
CONTACT PERSON IN CASE OF EMERGENCY: CONTACT NUMBER:

MERCEDITA T MANUEL 09063975678

BIRTH DATE: BIRTH PLACE:

JULY 20, 1969 BRGY DULIG, LABRADOR, PANGASINAN

CLUB PRESIDENT: (required) SIGNATURE: DATE: REGION:

Jan 10, 2024 STRXXXVI

Eagle Fortunato C. Villagarcia

REGIONAL MEMBERSHIP:(required) SIGNATURE: DATE: REMARKS:

COMMITTEE FOR MEMBERSHIP: SIGNATURE: DATE: REMARKS:

(LUZON, VISAYAS & MINDANAO)

Eagle ________________________

CLUB AFFILIATED: (TO BE FILLED UP BY APPLICANT)

REGIONAL GOVERNOR EY 2024: (TO BE FILLED UP BY THE GOVERNOR) MEMBER CONTROL NO.

Eagle GILMAR P. PARADO

APPLICANT’S SIGNATURE
REG. GOVERNOR SIGNATURE LATEST 2 X 2 PICTURE

INSTRUCTION:

ENDORSED BY: CHAIRMAN MEMBERSHIP 3.0 RENEWAL NOT REQUIRED ENDORSEMENT FROM COMMITTEE FOR
(Luzon, Visayas and Mindanao) MEMBERSHIP

4.0 NEW MEMBERHIP APPLICATION SHALL REQUIRES ENDORSEMENT

Eagle ________________________ FROM COMMITTEE ON MEMBERSHIP
NAME & SIGNATURE ABOVE
 NATIONAL I.D. APPLICATION FORM

NEW MEMBERSHIP / / RENEWAL

NAME (LASTNAME, FIRSTNAME, MIDDLE NAME) CLUB/ REG POSITION

PRADES, MARK MARVIN, BARROGA DKMEC/ CLUB SEC

HOME ADDRESS:

18-85 ZEN, PRIMEVILLE RESIDENCE, CAY POMBO, STA. MARIA, BULACAN

MOBILE NO. HEIGHT: WEIGHT: BLOOD RELIGION:
(FEET) (KGS) TYPE:
0956-4320-784 5’6” 80 “B+” ROMAN CATHOLIC
CONTACT PERSON IN CASE OF EMERGENCY: CONTACT NUMBER:

LIELA O PRADES - WIFE 09369426406

BIRTH DATE: BIRTH PLACE:

MAY 11, 1989 BRGY BANTAY, ILOCOS SUR

CLUB PRESIDENT: (required) SIGNATURE: DATE: REGION:

Jan 10, 2024 STRXXXVI

Eagle Fortunato C. Villagarcia

REGIONAL MEMBERSHIP:(required) SIGNATURE: DATE: REMARKS:

COMMITTEE FOR MEMBERSHIP: SIGNATURE: DATE: REMARKS:

(LUZON, VISAYAS & MINDANAO)

Eagle ________________________

CLUB AFFILIATED: (TO BE FILLED UP BY APPLICANT)

REGIONAL GOVERNOR EY 2024: (TO BE FILLED UP BY THE GOVERNOR) MEMBER CONTROL NO.

Eagle GILMAR P. PARADO

LATEST 2 X 2 PICTURE
REG. GOVERNOR SIGNATURE APPLICANT’S SIGNATURE

INSTRUCTION:

ENDORSED BY: CHAIRMAN MEMBERSHIP 5.0 RENEWAL NOT REQUIRED ENDORSEMENT FROM COMMITTEE FOR
(Luzon, Visayas and Mindanao) MEMBERSHIP

6.0 NEW MEMBERHIP APPLICATION SHALL REQUIRES ENDORSEMENT

Eagle ________________________ FROM COMMITTEE ON MEMBERSHIP
NAME & SIGNATURE ABOVE
 NATIONAL I.D. APPLICATION FORM

NEW MEMBERSHIP / / RENEWAL

NAME (LASTNAME, FIRSTNAME, MIDDLE NAME) CLUB/ REG POSITION

TAGUINOD, JONATHAN, CAMAYANG DKMEC/ CLUB BOD

HOME ADDRESS:

#1521 SAMAKA, VILLE, KAPALARAN EXIT, COMMONWEALTH, QUEZON CITY

MOBILE NO. HEIGHT: WEIGHT: BLOOD RELIGION:
(FEET) (KGS) TYPE:
0917-8357075 5’7” 71 “O” ROMAN CATHOLIC
CONTACT PERSON IN CASE OF EMERGENCY: CONTACT NUMBER:

MA SALVACION B TAGUINOD - WIFE 09399283604

BIRTH DATE: BIRTH PLACE:

AUG 15, 1977 TUGUEGARAO CITY

CLUB PRESIDENT: (required) SIGNATURE: DATE: REGION:

Jan 10, 2024 STRXXXVI

Eagle Fortunato C. Villagarcia

REGIONAL MEMBERSHIP:(required) SIGNATURE: DATE: REMARKS:

COMMITTEE FOR MEMBERSHIP: SIGNATURE: DATE: REMARKS:

(LUZON, VISAYAS & MINDANAO)

Eagle ________________________

CLUB AFFILIATED: (TO BE FILLED UP BY APPLICANT)

REGIONAL GOVERNOR EY 2024: (TO BE FILLED UP BY THE GOVERNOR) MEMBER CONTROL NO.

Eagle GILMAR P. PARADO

REG. GOVERNOR SIGNATURE APPLICANT’S SIGNATURE

INSTRUCTION:

ENDORSED BY: CHAIRMAN MEMBERSHIP 7.0 RENEWAL NOT REQUIRED ENDORSEMENT FROM COMMITTEE FOR
(Luzon, Visayas and Mindanao) MEMBERSHIP

8.0 NEW MEMBERHIP APPLICATION SHALL REQUIRES ENDORSEMENT

Eagle ________________________ FROM COMMITTEE ON MEMBERSHIP
NAME & SIGNATURE ABOVE
 NATIONAL I.D. APPLICATION FORM
NEW MEMBERSHIP / / RENEWAL

NAME (LASTNAME, FIRSTNAME, MIDDLE NAME) CLUB/ REG POSITION

ZOLETA, ROMMEL, DAMAYAN DKMEC/ CLUB BOD

HOME ADDRESS:

UNIT 222 ST. JOHN CONDOMINIUM, NO. 139 SCOUT RALLOS EXTENSION, SACRED HEART, QUEZON
MOBILE NO. HEIGHT: WEIGHT: BLOOD RELIGION:
(FEET) (KGS) TYPE:
0926-0429451 5’6” 68 “B” INC
CONTACT PERSON IN CASE OF EMERGENCY: CONTACT NUMBER:

CRIZEL ZOLETA - SIGUE 0925-8601984

BIRTH DATE: BIRTH PLACE:

APRIL 21, 1980 SASAN, MARINDUQUE

CLUB PRESIDENT: (required) SIGNATURE: DATE: REGION:

Jan 10, 2024 STRXXXVI

Eagle Fortunato C. Villagarcia

REGIONAL MEMBERSHIP:(required) SIGNATURE: DATE: REMARKS:

COMMITTEE FOR MEMBERSHIP: SIGNATURE: DATE: REMARKS:

(LUZON, VISAYAS & MINDANAO)

Eagle ________________________

CLUB AFFILIATED: (TO BE FILLED UP BY APPLICANT)

REGIONAL GOVERNOR EY 2024: (TO BE FILLED UP BY THE GOVERNOR) MEMBER CONTROL NO.

Eagle GILMAR P. PARADO

REG. GOVERNOR SIGNATURE APPLICANT’S SIGNATURE

INSTRUCTION:

ENDORSED BY: CHAIRMAN MEMBERSHIP 9.0 RENEWAL NOT REQUIRED ENDORSEMENT FROM COMMITTEE FOR
(Luzon, Visayas and Mindanao) MEMBERSHIP

10.0 NEW MEMBERHIP APPLICATION SHALL REQUIRES ENDORSEMENT

Eagle ________________________ FROM COMMITTEE ON MEMBERSHIP
NAME & SIGNATURE ABOVE
 NATIONAL I.D. APPLICATION FORM
NEW MEMBERSHIP / / RENEWAL

NAME (LASTNAME, FIRSTNAME, MIDDLE NAME) CLUB/ REG POSITION

PESTANO JR, ROLANDO, ZABALA DKMEC/ CLUB ASSEMBLYMAN

HOME ADDRESS:

#6054, MATIMYAS ST., DELA RAMA COMPOUND, GEN T. DE LEON VALENZUELA CITY
MOBILE NO. HEIGHT: WEIGHT: BLOOD RELIGION:
(FEET) (KGS) TYPE:
0926-0429451 5’7” 70 “A” ROMAN CATHOLIC
CONTACT PERSON IN CASE OF EMERGENCY: CONTACT NUMBER:

CHARISSE ANNE V PESTANO - WIFE 09152787199

BIRTH DATE: BIRTH PLACE:

JUNE 01, 1988 TACLOBAN LEYTE

CLUB PRESIDENT: (required) SIGNATURE: DATE: REGION:

Jan 10, 2024 STRXXXVI

Eagle Fortunato C. Villagarcia

REGIONAL MEMBERSHIP:(required) SIGNATURE: DATE: REMARKS:

COMMITTEE FOR MEMBERSHIP: SIGNATURE: DATE: REMARKS:

(LUZON, VISAYAS & MINDANAO)

Eagle ________________________

CLUB AFFILIATED: (TO BE FILLED UP BY APPLICANT)

REGIONAL GOVERNOR EY 2024: (TO BE FILLED UP BY THE GOVERNOR) MEMBER CONTROL NO.

Eagle GILMAR P. PARADO

APPLICANT’S SIGNATURE
REG. GOVERNOR SIGNATURE

INSTRUCTION:

ENDORSED BY: CHAIRMAN MEMBERSHIP 11.0 RENEWAL NOT REQUIRED ENDORSEMENT FROM COMMITTEE FOR
(Luzon, Visayas and Mindanao) MEMBERSHIP

12.0 NEW MEMBERHIP APPLICATION SHALL REQUIRES ENDORSEMENT

Eagle ________________________ FROM COMMITTEE ON MEMBERSHIP
NAME & SIGNATURE ABOVE
 NATIONAL I.D. APPLICATION FORM
NEW MEMBERSHIP / / RENEWAL

NAME (LASTNAME, FIRSTNAME, MIDDLE NAME) CLUB/ REG POSITION

CADATAL, MARK JEFFERSON, ARELLANO DKMEC/ CLUB COMELEC CHAIR

HOME ADDRESS:

U523 CIELO, BRGY MAYBUNGA, PASIG CITY

MOBILE NO. HEIGHT: WEIGHT: BLOOD RELIGION:
(FEET) (KGS) TYPE:
09088911056 5’7” 72 “A” ROMAN CATHOLIC
CONTACT PERSON IN CASE OF EMERGENCY: CONTACT NUMBER:

MARY JANE E CADATAL - WIFE 09088640595

BIRTH DATE: BIRTH PLACE:

JULY 17, 1987 TUGUEGARAO CITY

CLUB PRESIDENT: (required) SIGNATURE: DATE: REGION:

Jan 10, 2024 STRXXXVI

Eagle Fortunato C. Villagarcia

REGIONAL MEMBERSHIP:(required) SIGNATURE: DATE: REMARKS:

COMMITTEE FOR MEMBERSHIP: SIGNATURE: DATE: REMARKS:

(LUZON, VISAYAS & MINDANAO)

Eagle ________________________

CLUB AFFILIATED: (TO BE FILLED UP BY APPLICANT)

REGIONAL GOVERNOR EY 2024: (TO BE FILLED UP BY THE GOVERNOR) MEMBER CONTROL NO.

Eagle GILMAR P. PARADO

REG. GOVERNOR SIGNATURE APPLICANT’S SIGNATURE

INSTRUCTION:

ENDORSED BY: CHAIRMAN MEMBERSHIP 13.0 RENEWAL NOT REQUIRED ENDORSEMENT FROM COMMITTEE FOR
(Luzon, Visayas and Mindanao) MEMBERSHIP

14.0 NEW MEMBERHIP APPLICATION SHALL REQUIRES ENDORSEMENT

Eagle ________________________ FROM COMMITTEE ON MEMBERSHIP
NAME & SIGNATURE ABOVE
 NATIONAL I.D. APPLICATION FORM
NEW MEMBERSHIP / / RENEWAL

NAME (LASTNAME, FIRSTNAME, MIDDLE NAME) CLUB/ REG POSITION

TERENCIO, VINCENT, DALU DKMEC/ TRIBUNAL/GRIEVANCE

CHAIRMAN
HOME ADDRESS:

#BRIGHTON 4 BLOCK 01 LOT 50 LANCASTER NEW CITY GENERAL TRIAS CAVITE

MOBILE NO. HEIGHT: WEIGHT: BLOOD RELIGION:
(FEET) (KGS) TYPE:
09777513250 5’5” 68 “B” ROMAN CATHOLIC
CONTACT PERSON IN CASE OF EMERGENCY: CONTACT NUMBER:

ANALYN M TERENCIO - WIFE 09066630603

BIRTH DATE: BIRTH PLACE:

APRIL 10, 1985 TUGUEGARAO CITY

CLUB PRESIDENT: (required) SIGNATURE: DATE: REGION:

Jan 10, 2024 STRXXXVI

Eagle Fortunato C. Villagarcia

REGIONAL MEMBERSHIP:(required) SIGNATURE: DATE: REMARKS:

COMMITTEE FOR MEMBERSHIP: SIGNATURE: DATE: REMARKS:

(LUZON, VISAYAS & MINDANAO)

Eagle ________________________

CLUB AFFILIATED: (TO BE FILLED UP BY APPLICANT)

REGIONAL GOVERNOR EY 2024: (TO BE FILLED UP BY THE GOVERNOR) MEMBER CONTROL NO.

Eagle GILMAR P. PARADO

REG. GOVERNOR SIGNATURE APPLICANT’S SIGNATURE

INSTRUCTION:

ENDORSED BY: CHAIRMAN MEMBERSHIP 15.0 RENEWAL NOT REQUIRED ENDORSEMENT FROM COMMITTEE FOR
(Luzon, Visayas and Mindanao) MEMBERSHIP

16.0 NEW MEMBERHIP APPLICATION SHALL REQUIRES ENDORSEMENT

Eagle ________________________ FROM COMMITTEE ON MEMBERSHIP
NAME & SIGNATURE ABOVE
 NATIONAL I.D. APPLICATION FORM
NEW MEMBERSHIP / / RENEWAL

NAME (LASTNAME, FIRSTNAME, MIDDLE NAME) CLUB/ REG POSITION

TUNGCUL, DOMINGO, BALLAD DKMEC/ CLUB ALTERNATE

REGIONAL ASSEMBLYMEN
HOME ADDRESS:

EASTWOOD RESIDENCE, P9 BLK 11, LOT 22, SAN ISIDRO, MONTALBAN, RIZAL
MOBILE NO. HEIGHT: WEIGHT: BLOOD RELIGION:
(FEET) (KGS) TYPE:
0927-6642403 5’7” 78 “O” ROMAN CATHOLIC
CONTACT PERSON IN CASE OF EMERGENCY: CONTACT NUMBER:

JANE A TUNGCUL 09269390292

BIRTH DATE: BIRTH PLACE:

APRIL 16, 1988 Dodan Peñablanca, Cagayan

CLUB PRESIDENT: (required) SIGNATURE: DATE: REGION:

Jan 10, 2024 STRXXXVI

Eagle Fortunato C. Villagarcia

REGIONAL MEMBERSHIP:(required) SIGNATURE: DATE: REMARKS:

COMMITTEE FOR MEMBERSHIP: SIGNATURE: DATE: REMARKS:

(LUZON, VISAYAS & MINDANAO)

Eagle ________________________

CLUB AFFILIATED: (TO BE FILLED UP BY APPLICANT)

REGIONAL GOVERNOR EY 2024: (TO BE FILLED UP BY THE GOVERNOR) MEMBER CONTROL NO.

Eagle GILMAR P. PARADO

REG. GOVERNOR SIGNATURE APPLICANT’S SIGNATURE

INSTRUCTION:

ENDORSED BY: CHAIRMAN MEMBERSHIP 17.0 RENEWAL NOT REQUIRED ENDORSEMENT FROM COMMITTEE FOR
(Luzon, Visayas and Mindanao) MEMBERSHIP

18.0 NEW MEMBERHIP APPLICATION SHALL REQUIRES ENDORSEMENT

Eagle ________________________ FROM COMMITTEE ON MEMBERSHIP
NAME & SIGNATURE ABOVE
 NATIONAL I.D. APPLICATION FORM
NEW MEMBERSHIP / / RENEWAL

NAME (LASTNAME, FIRSTNAME, MIDDLE NAME) CLUB/ REG POSITION

APOSTOL, ROBERTO, ASTORGA DKMEC/ CLUB CARE CHAIRMAN

HOME ADDRESS:

PHASE 8 P-KG 1 B BLOCK 10 L2, BRGY 176 BAGONG SILANG CALOOCAN CITY
MOBILE NO. HEIGHT: WEIGHT: BLOOD RELIGION:
(FEET) (KGS) TYPE:
09165907607 5’5” 54 “O” ROMAN CATHOLIC
CONTACT PERSON IN CASE OF EMERGENCY: CONTACT NUMBER:

MARIA FE B APOSTOL - WIFE 09673203348

BIRTH DATE: BIRTH PLACE:

FEB 27, 1965 TONDO, MANILA

CLUB PRESIDENT: (required) SIGNATURE: DATE: REGION:

Jan 10, 2024 STRXXXVI

Eagle Fortunato C. Villagarcia

REGIONAL MEMBERSHIP:(required) SIGNATURE: DATE: REMARKS:

COMMITTEE FOR MEMBERSHIP: SIGNATURE: DATE: REMARKS:

(LUZON, VISAYAS & MINDANAO)

Eagle ________________________

CLUB AFFILIATED: (TO BE FILLED UP BY APPLICANT)

REGIONAL GOVERNOR EY 2024: (TO BE FILLED UP BY THE GOVERNOR) MEMBER CONTROL NO.

Eagle GILMAR P. PARADO

REG. GOVERNOR SIGNATURE APPLICANT’S SIGNATURE

INSTRUCTION:

ENDORSED BY: CHAIRMAN MEMBERSHIP 19.0 RENEWAL NOT REQUIRED ENDORSEMENT FROM COMMITTEE FOR
(Luzon, Visayas and Mindanao) MEMBERSHIP

20.0 NEW MEMBERHIP APPLICATION SHALL REQUIRES ENDORSEMENT

Eagle ________________________ FROM COMMITTEE ON MEMBERSHIP
NAME & SIGNATURE ABOVE
 NATIONAL I.D. APPLICATION FORM
NEW MEMBERSHIP / / RENEWAL

NAME (LASTNAME, FIRSTNAME, MIDDLE NAME) CLUB/ REG POSITION

ARCENAS JR, JERRY, FABRINGAR DKMEC/ CLUB PEACE OFFICER

HOME ADDRESS:

LOT 3, BLK 4, LUZYVILLE RESIDENTS, BRGY LATAG, LIPA CITY, BATANGAS

MOBILE NO. HEIGHT: WEIGHT: BLOOD RELIGION:
(FEET) (KGS) TYPE:
0916-2805918 5’9” 75 “B+” PROTESTANT
CONTACT PERSON IN CASE OF EMERGENCY: CONTACT NUMBER:

MELANIE D ARCENAS - WIFE 09457802838

BIRTH DATE: BIRTH PLACE:

APRIL 23, 1980 SARALLA, SOUTH COTABATO

CLUB PRESIDENT: (required) SIGNATURE: DATE: REGION:

Jan 10, 2024 STRXXXVI

Eagle Fortunato C. Villagarcia

REGIONAL MEMBERSHIP:(required) SIGNATURE: DATE: REMARKS:

COMMITTEE FOR MEMBERSHIP: SIGNATURE: DATE: REMARKS:

(LUZON, VISAYAS & MINDANAO)

Eagle ________________________

CLUB AFFILIATED: (TO BE FILLED UP BY APPLICANT)

REGIONAL GOVERNOR EY 2024: (TO BE FILLED UP BY THE GOVERNOR) MEMBER CONTROL NO.

Eagle GILMAR P. PARADO

REG. GOVERNOR SIGNATURE APPLICANT’S SIGNATURE

INSTRUCTION:

ENDORSED BY: CHAIRMAN MEMBERSHIP 21.0 RENEWAL NOT REQUIRED ENDORSEMENT FROM COMMITTEE FOR
(Luzon, Visayas and Mindanao) MEMBERSHIP

22.0 NEW MEMBERHIP APPLICATION SHALL REQUIRES ENDORSEMENT

Eagle ________________________ FROM COMMITTEE ON MEMBERSHIP
NAME & SIGNATURE ABOVE
 NATIONAL I.D. APPLICATION FORM
NEW MEMBERSHIP / / RENEWAL

NAME (LASTNAME, FIRSTNAME, MIDDLE NAME) CLUB/ REG POSITION

BALMACEDA, CHARLES AIRWEEN, MEDENILLA DKMEC/ CLUB MEMBERSHIP

CHAIRMAN
HOME ADDRESS:

BLOCK 4 LOT 23 PRIMROSE ST BLOOMFIELDS SUBDIVISION BRGY PASONG PUTIK NOVALICHES QUEZON
CITY
MOBILE NO. HEIGHT: WEIGHT: BLOOD RELIGION:
(FEET) (KGS) TYPE:
09326460383 5’6” 62 “O+” ROMAN CATHOLIC
CONTACT PERSON IN CASE OF EMERGENCY: CONTACT NUMBER:

EDZEL B BALMACEDA 09685446190

BIRTH DATE: BIRTH PLACE:

AUG 04, 1990 QUEZON CITY

CLUB PRESIDENT: (required) SIGNATURE: DATE: REGION:

Jan 10, 2024 STRXXXVI

Eagle Fortunato C. Villagarcia

REGIONAL MEMBERSHIP:(required) SIGNATURE: DATE: REMARKS:

COMMITTEE FOR MEMBERSHIP: SIGNATURE: DATE: REMARKS:

(LUZON, VISAYAS & MINDANAO)

Eagle ________________________

CLUB AFFILIATED: (TO BE FILLED UP BY APPLICANT)

REGIONAL GOVERNOR EY 2024: (TO BE FILLED UP BY THE GOVERNOR) MEMBER CONTROL NO.

Eagle GILMAR P. PARADO

REG. GOVERNOR SIGNATURE APPLICANT’S SIGNATURE

INSTRUCTION:

ENDORSED BY: CHAIRMAN MEMBERSHIP 23.0 RENEWAL NOT REQUIRED ENDORSEMENT FROM COMMITTEE FOR
(Luzon, Visayas and Mindanao) MEMBERSHIP

24.0 NEW MEMBERHIP APPLICATION SHALL REQUIRES ENDORSEMENT

Eagle ________________________ FROM COMMITTEE ON MEMBERSHIP
NAME & SIGNATURE ABOVE
 NATIONAL I.D. APPLICATION FORM
NEW MEMBERSHIP / / RENEWAL

NAME (LASTNAME, FIRSTNAME, MIDDLE NAME) CLUB/ REG POSITION

CAMMAGAY, JEROME, TUMALIUAN DKMEC/ CLUB AUDITOR

HOME ADDRESS:

BLK 18 LOT 20 LANGKA ST. MANGGA 3 PINAGBUHATAN, PASIG CITY

MOBILE NO. HEIGHT: WEIGHT: BLOOD RELIGION:
(FEET) (KGS) TYPE:
09089115295 5’6” 70 “O” ROMAN CATHOLIC
CONTACT PERSON IN CASE OF EMERGENCY: CONTACT NUMBER:

LORIBELLE S CAMMAGAY - WIFE 09982826185

BIRTH DATE: BIRTH PLACE:

DEC 12, 1995 Cebu city

CLUB PRESIDENT: (required) SIGNATURE: DATE: REGION:

Jan 10, 2024 STRXXXVI

Eagle Fortunato C. Villagarcia

REGIONAL MEMBERSHIP:(required) SIGNATURE: DATE: REMARKS:

COMMITTEE FOR MEMBERSHIP: SIGNATURE: DATE: REMARKS:

(LUZON, VISAYAS & MINDANAO)

Eagle ________________________

CLUB AFFILIATED: (TO BE FILLED UP BY APPLICANT)

REGIONAL GOVERNOR EY 2024: (TO BE FILLED UP BY THE GOVERNOR) MEMBER CONTROL NO.

Eagle GILMAR P. PARADO

REG. GOVERNOR SIGNATURE APPLICANT’S SIGNATURE

INSTRUCTION:

ENDORSED BY: CHAIRMAN MEMBERSHIP 25.0 RENEWAL NOT REQUIRED ENDORSEMENT FROM COMMITTEE FOR
(Luzon, Visayas and Mindanao) MEMBERSHIP

26.0 NEW MEMBERHIP APPLICATION SHALL REQUIRES ENDORSEMENT

Eagle ________________________ FROM COMMITTEE ON MEMBERSHIP
NAME & SIGNATURE ABOVE
 TFOE-Form NATIONAL I.D. APPLICATION FORM
2 NEW MEMBERSHIP / / RENEWAL

NAME (LASTNAME, FIRSTNAME, MIDDLE NAME) CLUB/ REG POSITION

CATUBIG, JOMAR, PALMA DKMEC/ CLUB

HOME ADDRESS:

422 EP LIVING QUARTERS BLDG A, CAMP GEN EMILIO AGUINALDO, QUEZON CITY
MOBILE NO. HEIGHT: WEIGHT: BLOOD RELIGION:
(FEET) (KGS) TYPE:
09772079979 5’6” 71 “b” ROMAN CATHOLIC
CONTACT PERSON IN CASE OF EMERGENCY: CONTACT NUMBER:

MARY ANN R CATUBIG - WIFE 09077184079

BIRTH DATE: BIRTH PLACE:

JANUARY 18, 1989 STO DOMINGO, NUEVA ECIJA

CLUB PRESIDENT: (required) SIGNATURE: DATE: REGION:

Jan 10, 2024 STRXXXVI

Eagle Fortunato C. Villagarcia

REGIONAL MEMBERSHIP:(required) SIGNATURE: DATE: REMARKS:

COMMITTEE FOR MEMBERSHIP: SIGNATURE: DATE: REMARKS:

(LUZON, VISAYAS & MINDANAO)

Eagle ________________________

CLUB AFFILIATED: (TO BE FILLED UP BY APPLICANT)

REGIONAL GOVERNOR EY 2024: (TO BE FILLED UP BY THE GOVERNOR) MEMBER CONTROL NO.

Eagle GILMAR P. PARADO

REG. GOVERNOR SIGNATURE APPLICANT’S SIGNATURE

INSTRUCTION:

ENDORSED BY: CHAIRMAN MEMBERSHIP 27.0 RENEWAL NOT REQUIRED ENDORSEMENT FROM COMMITTEE FOR
(Luzon, Visayas and Mindanao) MEMBERSHIP

28.0 NEW MEMBERHIP APPLICATION SHALL REQUIRES ENDORSEMENT

Eagle ________________________ FROM COMMITTEE ON MEMBERSHIP
NAME & SIGNATURE ABOVE
 NATIONAL I.D. APPLICATION FORM
NEW MEMBERSHIP / / RENEWAL

NAME (LASTNAME, FIRSTNAME, MIDDLE NAME) CLUB/ REG POSITION

TFOE-Form
2 DIONIO, JAZRAEL, BERNAS DKMEC/ CLUB INFORMATION
OFFICER
HOME ADDRESS:

1521 SAMAKA, VILLE, KAPALARAN EXIT, COMMONWEALTH, QUEZON CITY

MOBILE NO. HEIGHT: WEIGHT: BLOOD RELIGION:
(FEET) (KGS) TYPE:
09656209032 5’7” 81 “B+” ROMAN CATHOLIC
CONTACT PERSON IN CASE OF EMERGENCY: CONTACT NUMBER:

JONALYN CALLAMAN DIONIO - WIFE 09514746185

BIRTH DATE: BIRTH PLACE:

May 23, 1995 CEBU CITY

CLUB PRESIDENT: (required) SIGNATURE: DATE: REGION:

Jan 10, 2024 STRXXXVI

Eagle Fortunato C. Villagarcia

REGIONAL MEMBERSHIP:(required) SIGNATURE: DATE: REMARKS:

COMMITTEE FOR MEMBERSHIP: SIGNATURE: DATE: REMARKS:

(LUZON, VISAYAS & MINDANAO)

Eagle ________________________

CLUB AFFILIATED: (TO BE FILLED UP BY APPLICANT)

REGIONAL GOVERNOR EY 2024: (TO BE FILLED UP BY THE GOVERNOR) MEMBER CONTROL NO.

Eagle GILMAR P. PARADO

REG. GOVERNOR SIGNATURE APPLICANT’S SIGNATURE

INSTRUCTION:

ENDORSED BY: CHAIRMAN MEMBERSHIP 29.0 RENEWAL NOT REQUIRED ENDORSEMENT FROM COMMITTEE FOR
(Luzon, Visayas and Mindanao) MEMBERSHIP

30.0 NEW MEMBERHIP APPLICATION SHALL REQUIRES ENDORSEMENT

Eagle ________________________ FROM COMMITTEE ON MEMBERSHIP
NAME & SIGNATURE ABOVE
 NATIONAL I.D. APPLICATION FORM
NEW MEMBERSHIP / / RENEWAL

NAME (LASTNAME, FIRSTNAME, MIDDLE NAME) CLUB/ REG POSITION

TFOE-Form
2 ENGCOY, RONIE, ALGABRE DKMEC/ CLUB PROTOCOL
OFFICER
HOME ADDRESS:

PHASE 1-A BLK 354 LOT. 11-13 LA SOLIDARIDAD ESTATE HOMES BRGY SAN ISIDRO RODRIGUEZ, RIZAL
MOBILE NO. HEIGHT: WEIGHT: BLOOD RELIGION:
(FEET) (KGS) TYPE:
09369003871 5’6” 77 “AB” ROMAN CATHOLIC
CONTACT PERSON IN CASE OF EMERGENCY: CONTACT NUMBER:

ROSETTE E ENGCOY - WIFE 09635038381

BIRTH DATE: BIRTH PLACE:

APRIL 02, 1989 TAGUM CITY

CLUB PRESIDENT: (required) SIGNATURE: DATE: REGION:

Jan 10, 2024 STRXXXVI

Eagle Fortunato C. Villagarcia

REGIONAL MEMBERSHIP:(required) SIGNATURE: DATE: REMARKS:

COMMITTEE FOR MEMBERSHIP: SIGNATURE: DATE: REMARKS:

(LUZON, VISAYAS & MINDANAO)

Eagle ________________________

CLUB AFFILIATED: (TO BE FILLED UP BY APPLICANT)

REGIONAL GOVERNOR EY 2024: (TO BE FILLED UP BY THE GOVERNOR) MEMBER CONTROL NO.

Eagle GILMAR P. PARADO

REG. GOVERNOR SIGNATURE APPLICANT’S SIGNATURE

INSTRUCTION:

ENDORSED BY: CHAIRMAN MEMBERSHIP 31.0 RENEWAL NOT REQUIRED ENDORSEMENT FROM COMMITTEE FOR
(Luzon, Visayas and Mindanao) MEMBERSHIP

32.0 NEW MEMBERHIP APPLICATION SHALL REQUIRES ENDORSEMENT

Eagle ________________________ FROM COMMITTEE ON MEMBERSHIP
NAME & SIGNATURE ABOV
 NATIONAL I.D. APPLICATION FORM
NEW MEMBERSHIP / / RENEWAL

NAME (LASTNAME, FIRSTNAME, MIDDLE NAME) CLUB/ REG POSITION

CABILI, FARLEY, MARIN DKMEC/ CLUB BOD

HOME ADDRESS:

B14 L2 WOODPECKER ST., ZABARTE SUBD., NOVALICHES, QUEZON CITY

MOBILE NO. HEIGHT: WEIGHT: BLOOD RELIGION:
(FEET) (KGS) TYPE:
09564418261 5’7” 71 “A” ROMAN CATHOLIC
CONTACT PERSON IN CASE OF EMERGENCY: CONTACT NUMBER:

MARIA TRICIA CABILI 009369400793

BIRTH DATE: BIRTH PLACE:

FEB 14, 1974 MANILA

CLUB PRESIDENT: (required) SIGNATURE: DATE: REGION:

Jan 10, 2024 STRXXXVI

Eagle Fortunato C. Villagarcia

REGIONAL MEMBERSHIP:(required) SIGNATURE: DATE: REMARKS:

COMMITTEE FOR MEMBERSHIP: SIGNATURE: DATE: REMARKS:

(LUZON, VISAYAS & MINDANAO)

Eagle ________________________

CLUB AFFILIATED: (TO BE FILLED UP BY APPLICANT)

REGIONAL GOVERNOR EY 2024: (TO BE FILLED UP BY THE GOVERNOR) MEMBER CONTROL NO.

Eagle GILMAR P. PARADO

REG. GOVERNOR SIGNATURE APPLICANT’S SIGNATURE

INSTRUCTION:

ENDORSED BY: CHAIRMAN MEMBERSHIP 33.0 RENEWAL NOT REQUIRED ENDORSEMENT FROM COMMITTEE FOR
(Luzon, Visayas and Mindanao) MEMBERSHIP

34.0 NEW MEMBERHIP APPLICATION SHALL REQUIRES ENDORSEMENT

Eagle ________________________ FROM COMMITTEE ON MEMBERSHIP
NAME & SIGNATURE ABOV
 NATIONAL I.D. APPLICATION FORM
NEW MEMBERSHIP / / RENEWAL

NAME (LASTNAME, FIRSTNAME, MIDDLE NAME) CLUB/ REG POSITION

MADRIAGO, DEODELIO, GARINGAGAO DKMEC/ CLUB ALTERNATE

REGIONAL ASSEMBLYMAN
HOME ADDRESS:

E-4B, J FERNANDO AVE., CAMP GEN EMILIO AGUINALOD, QUEZON CITY

MOBILE NO. HEIGHT: WEIGHT: BLOOD RELIGION:
(FEET) (KGS) TYPE:
09998276454 5’6” 74 “B” ROMAN CATHOLIC
CONTACT PERSON IN CASE OF EMERGENCY: CONTACT NUMBER:

ANALIZA L MADRIAGO - WIFE 09167375738

BIRTH DATE: BIRTH PLACE:

FEBRUARY 12, 1981 RIZAL, NUEVA ECIJA

CLUB PRESIDENT: (required) SIGNATURE: DATE: REGION:

Jan 10, 2024 STRXXXVI

Eagle Fortunato C. Villagarcia

REGIONAL MEMBERSHIP:(required) SIGNATURE: DATE: REMARKS:

COMMITTEE FOR MEMBERSHIP: SIGNATURE: DATE: REMARKS:

(LUZON, VISAYAS & MINDANAO)

Eagle ________________________

CLUB AFFILIATED: (TO BE FILLED UP BY APPLICANT)

REGIONAL GOVERNOR EY 2024: (TO BE FILLED UP BY THE GOVERNOR) MEMBER CONTROL NO.

Eagle GILMAR P. PARADO

LATEST 2 X 2 PIC

REG. GOVERNOR SIGNATURE APPLICANT’S SIGNATURE

INSTRUCTION:

ENDORSED BY: CHAIRMAN MEMBERSHIP 35.0 RENEWAL NOT REQUIRED ENDORSEMENT FROM COMMITTEE FOR
(Luzon, Visayas and Mindanao) MEMBERSHIP

36.0 NEW MEMBERHIP APPLICATION SHALL REQUIRES ENDORSEMENT

Eagle ________________________ FROM COMMITTEE ON MEMBERSHIP
NAME & SIGNATURE ABOVE
 TFOE-Form
2 NATIONAL I.D. APPLICATION FORM
NEW MEMBERSHIP / / RENEWAL

NAME (LASTNAME, FIRSTNAME, MIDDLE NAME) CLUB/ REG POSITION

LUCENA, RODEL, ROTUGAL DKMEC/ CLUB BOD

HOME ADDRESS:

B4 L9, PRIMROSE ST., BLOOMFIELDS SUBDIVISION, BRGY PASONG PUTIK, NOVALICHES, QUEZON CITY
MOBILE NO. HEIGHT: WEIGHT: BLOOD RELIGION:
(FEET) (KGS) TYPE:
0910195771 5’7” 65 “O” ROMAN CATHOLIC
CONTACT PERSON IN CASE OF EMERGENCY: CONTACT NUMBER:

EDNA R LUCENA - WIFE 09177984918

BIRTH DATE: BIRTH PLACE:

JUL 20, 1976 DARAGA, INARADO, ALBAY

CLUB PRESIDENT: (required) SIGNATURE: DATE: REGION:

Jan 10, 2024 STRXXXVI

Eagle Fortunato C. Villagarcia

REGIONAL MEMBERSHIP:(required) SIGNATURE: DATE: REMARKS:

COMMITTEE FOR MEMBERSHIP: SIGNATURE: DATE: REMARKS:

(LUZON, VISAYAS & MINDANAO)

Eagle ________________________

CLUB AFFILIATED: (TO BE FILLED UP BY APPLICANT)

REGIONAL GOVERNOR EY 2024: (TO BE FILLED UP BY THE GOVERNOR) MEMBER CONTROL NO.

Eagle GILMAR P. PARADO

REG. GOVERNOR SIGNATURE APPLICANT’S SIGNATURE

INSTRUCTION:

ENDORSED BY: CHAIRMAN MEMBERSHIP 37.0 RENEWAL NOT REQUIRED ENDORSEMENT FROM COMMITTEE FOR
(Luzon, Visayas and Mindanao) MEMBERSHIP

38.0 NEW MEMBERHIP APPLICATION SHALL REQUIRES ENDORSEMENT

Eagle ________________________ FROM COMMITTEE ON MEMBERSHIP
NAME & SIGNATURE ABOVE
 TFOE-Form
2 NATIONAL I.D. APPLICATION FORM
NEW MEMBERSHIP / / RENEWAL

NAME (LASTNAME, FIRSTNAME, MIDDLE NAME) CLUB/ REG POSITION

MAGNO, RENIE S DKMEC/ CLUB PEACE OFFICER

HOME ADDRESS:

BRGY SAMPALOC, TANAY, RIZAL

MOBILE NO. HEIGHT: WEIGHT: BLOOD RELIGION:
(FEET) (KGS) TYPE:
0917-8357075 5’7” 62 “A” ROMAN CATHOLIC
CONTACT PERSON IN CASE OF EMERGENCY: CONTACT NUMBER:

09514746185
BIRTH DATE: BIRTH PLACE:

JAN 11, 1975 LAMBUNAO, ILOILO CITY

CLUB PRESIDENT: (required) SIGNATURE: DATE: REGION:

Jan 10, 2024 STRXXXVI

Eagle Fortunato C. Villagarcia

REGIONAL MEMBERSHIP:(required) SIGNATURE: DATE: REMARKS:

COMMITTEE FOR MEMBERSHIP: SIGNATURE: DATE: REMARKS:

(LUZON, VISAYAS & MINDANAO)

Eagle ________________________

CLUB AFFILIATED: (TO BE FILLED UP BY APPLICANT)

REGIONAL GOVERNOR EY 2024: (TO BE FILLED UP BY THE GOVERNOR) MEMBER CONTROL NO.

Eagle GILMAR P. PARADO

REG. GOVERNOR SIGNATURE APPLICANT’S SIGNATURE

INSTRUCTION:

ENDORSED BY: CHAIRMAN MEMBERSHIP 39.0 RENEWAL NOT REQUIRED ENDORSEMENT FROM COMMITTEE FOR
(Luzon, Visayas and Mindanao) MEMBERSHIP

40.0 NEW MEMBERHIP APPLICATION SHALL REQUIRES ENDORSEMENT

Eagle ________________________ FROM COMMITTEE ON MEMBERSHIP
NAME & SIGNATURE ABOVE
 TFOE-Form
2 NATIONAL I.D. APPLICATION FORM
NEW MEMBERSHIP / / RENEWAL

NAME (LASTNAME, FIRSTNAME, MIDDLE NAME) CLUB/ REG POSITION

MANGUNDAYAO, MARVIN, IMBAG DKMEC/ CLUB PEACE OFFICER

HOME ADDRESS:

ZONE 1, BRGY FORT BONIFACIO, TAGUIG CITY

MOBILE NO. HEIGHT: WEIGHT: BLOOD RELIGION:
(FEET) (KGS) TYPE:
09260774800 5’6” 60 “O” ROMAN CATHOLIC
CONTACT PERSON IN CASE OF EMERGENCY: CONTACT NUMBER:

MA. CHERYLL I MANGUNDAYAO - MOTHER 09663862931

BIRTH DATE: BIRTH PLACE:

SEP 13, 1990 PASAY CITY

CLUB PRESIDENT: (required) SIGNATURE: DATE: REGION:

Jan 10, 2024 STRXXXVI

Eagle Fortunato C. Villagarcia

REGIONAL MEMBERSHIP:(required) SIGNATURE: DATE: REMARKS:

COMMITTEE FOR MEMBERSHIP: SIGNATURE: DATE: REMARKS:

(LUZON, VISAYAS & MINDANAO)

Eagle ________________________

CLUB AFFILIATED: (TO BE FILLED UP BY APPLICANT)

REGIONAL GOVERNOR EY 2024: (TO BE FILLED UP BY THE GOVERNOR) MEMBER CONTROL NO.

Eagle GILMAR P. PARADO

REG. GOVERNOR SIGNATURE APPLICANT’S SIGNATURE

INSTRUCTION:

ENDORSED BY: CHAIRMAN MEMBERSHIP 41.0 RENEWAL NOT REQUIRED ENDORSEMENT FROM COMMITTEE FOR
(Luzon, Visayas and Mindanao) MEMBERSHIP

42.0 NEW MEMBERHIP APPLICATION SHALL REQUIRES ENDORSEMENT

Eagle ________________________ FROM COMMITTEE ON MEMBERSHIP
NAME & SIGNATURE ABOV
 TFOE-Form
2 NATIONAL I.D. APPLICATION FORM
NEW MEMBERSHIP / / RENEWAL

NAME (LASTNAME, FIRSTNAME, MIDDLE NAME) CLUB/ REG POSITION

MEDENILLA, ARIEL, ABUED DKMEC/ CLUB REGIONAL

ASSEMBLYMEN
HOME ADDRESS:

BLOCK 4 LOT 23 PRIMROSE ST BLOOMFIELDS SUBDIVISION BRGY PASONG PUTIK NOVALICHES QUEZON
CITY
MOBILE NO. HEIGHT: WEIGHT: BLOOD RELIGION:
(FEET) (KGS) TYPE:
0918-4996898 5’9” 95 “O” CHRISTIAN
CONTACT PERSON IN CASE OF EMERGENCY: CONTACT NUMBER:

ANNIE MEDENILLA - WIFE 09985557212

BIRTH DATE: BIRTH PLACE:

MAR 10, 1975 LUCENA CITY

CLUB PRESIDENT: (required) SIGNATURE: DATE: REGION:

Jan 10, 2024 STRXXXVI

Eagle Fortunato C. Villagarcia

REGIONAL MEMBERSHIP:(required) SIGNATURE: DATE: REMARKS:

COMMITTEE FOR MEMBERSHIP: SIGNATURE: DATE: REMARKS:

(LUZON, VISAYAS & MINDANAO)

Eagle ________________________

CLUB AFFILIATED: (TO BE FILLED UP BY APPLICANT)

REGIONAL GOVERNOR EY 2024: (TO BE FILLED UP BY THE GOVERNOR) MEMBER CONTROL NO.

Eagle GILMAR P. PARADO

REG. GOVERNOR SIGNATURE APPLICANT’S SIGNATURE

INSTRUCTION:

ENDORSED BY: CHAIRMAN MEMBERSHIP 43.0 RENEWAL NOT REQUIRED ENDORSEMENT FROM COMMITTEE FOR
(Luzon, Visayas and Mindanao) MEMBERSHIP

44.0 NEW MEMBERHIP APPLICATION SHALL REQUIRES ENDORSEMENT

Eagle ________________________ FROM COMMITTEE ON MEMBERSHIP
NAME & SIGNATURE ABOVE
 TFOE-Form
2 NATIONAL I.D. APPLICATION FORM

NEW MEMBERSHIP / / RENEWAL

NAME (LASTNAME, FIRSTNAME, MIDDLE NAME) CLUB/ REG POSITION

PEDRABUENA, JAIME, PALAD DKMEC/ CLUB PEACE OFFICER

HOME ADDRESS:

#1521 SAMAKA, VILLE, KAPALARAN EXIT, COMMONWEALTH, QUEZON CITY

MOBILE NO. HEIGHT: WEIGHT: BLOOD RELIGION:
(FEET) (KGS) TYPE:
09485658713 5’7” 74 “B” ROMAN CATHOLIC
CONTACT PERSON IN CASE OF EMERGENCY: CONTACT NUMBER:

JOSEPHINE PEDRABUENA - WIFE 09158539670

BIRTH DATE: BIRTH PLACE:

MAR 01, 1977 POLANCO, ZAMBOANGA DEL NORTE

CLUB PRESIDENT: (required) SIGNATURE: DATE: REGION:

Jan 10, 2024 STRXXXVI

Eagle Fortunato C. Villagarcia

REGIONAL MEMBERSHIP:(required) SIGNATURE: DATE: REMARKS:

COMMITTEE FOR MEMBERSHIP: SIGNATURE: DATE: REMARKS:

(LUZON, VISAYAS & MINDANAO)

Eagle ________________________

CLUB AFFILIATED: (TO BE FILLED UP BY APPLICANT)

REGIONAL GOVERNOR EY 2024: (TO BE FILLED UP BY THE GOVERNOR) MEMBER CONTROL NO.

Eagle GILMAR P. PARADO

REG. GOVERNOR SIGNATURE APPLICANT’S SIGNATURE

INSTRUCTION:

ENDORSED BY: CHAIRMAN MEMBERSHIP 45.0 RENEWAL NOT REQUIRED ENDORSEMENT FROM COMMITTEE FOR
(Luzon, Visayas and Mindanao) MEMBERSHIP

46.0 NEW MEMBERHIP APPLICATION SHALL REQUIRES ENDORSEMENT

Eagle ________________________ FROM COMMITTEE ON MEMBERSHIP
NAME & SIGNATURE ABOV
 TFOE-Form
2 NATIONAL I.D. APPLICATION FORM
NEW MEMBERSHIP / / RENEWAL

NAME (LASTNAME, FIRSTNAME, MIDDLE NAME) CLUB/ REG POSITION

PUIG, BERDIN, DIORDA DKMEC/ CLUB VICE PRESIDENT

HOME ADDRESS:

EMQ3 DOOR7, BAYANI ROAD, FORT BONIFACIO, TAGUIG CITY

MOBILE NO. HEIGHT: WEIGHT: BLOOD RELIGION:
(FEET) (KGS) TYPE:
09456008310 5’6” 74 “B” ROMAN CATHOLIC
CONTACT PERSON IN CASE OF EMERGENCY: CONTACT NUMBER:

MARY JEAN VG PUIG - WIFE 09952333717

BIRTH DATE: BIRTH PLACE:

December 13, 1973 SAN ENRIQUE, ILOILO

CLUB PRESIDENT: (required) SIGNATURE: DATE: REGION:

Jan 10, 2024 STRXXXVI

Eagle Fortunato C. Villagarcia

REGIONAL MEMBERSHIP:(required) SIGNATURE: DATE: REMARKS:

COMMITTEE FOR MEMBERSHIP: SIGNATURE: DATE: REMARKS:

(LUZON, VISAYAS & MINDANAO)

Eagle ________________________

CLUB AFFILIATED: (TO BE FILLED UP BY APPLICANT)

REGIONAL GOVERNOR EY 2024: (TO BE FILLED UP BY THE GOVERNOR) MEMBER CONTROL NO.

Eagle GILMAR P. PARADO

REG. GOVERNOR SIGNATURE APPLICANT’S SIGNATURE

INSTRUCTION:

ENDORSED BY: CHAIRMAN MEMBERSHIP 47.0 RENEWAL NOT REQUIRED ENDORSEMENT FROM COMMITTEE FOR
(Luzon, Visayas and Mindanao) MEMBERSHIP

48.0 NEW MEMBERHIP APPLICATION SHALL REQUIRES ENDORSEMENT

Eagle ________________________ FROM COMMITTEE ON MEMBERSHIP
NAME & SIGNATURE ABOV
 TFOE-Form
2 NATIONAL I.D. APPLICATION FORM
NEW MEMBERSHIP / / RENEWAL

NAME (LASTNAME, FIRSTNAME, MIDDLE NAME) CLUB/ REG POSITION

SANTOS, JOHN MEGNEL CRUZ DKMEC/ CLUB VICE CARE

CHAIRMAN
HOME ADDRESS:

B3 L54 CARNATION ST., BLOOMFIELDS SUBDIVISION, BRGY PASONG PUTIK, NOVALICHES, QC

MOBILE NO. HEIGHT: WEIGHT: BLOOD RELIGION:
(FEET) (KGS) TYPE:
0916-3785291 5’9” 82 “AB” ROMAN CATHOLIC
CONTACT PERSON IN CASE OF EMERGENCY: CONTACT NUMBER:

NICOLE SANTOS - WIFE 09176691782

BIRTH DATE: BIRTH PLACE:

JULY 21, 1991 QUEZON CITY

CLUB PRESIDENT: (required) SIGNATURE: DATE: REGION:

Jan 10, 2024 STRXXXVI

Eagle Fortunato C. Villagarcia

REGIONAL MEMBERSHIP:(required) SIGNATURE: DATE: REMARKS:

COMMITTEE FOR MEMBERSHIP: SIGNATURE: DATE: REMARKS:

(LUZON, VISAYAS & MINDANAO)

Eagle ________________________

CLUB AFFILIATED: (TO BE FILLED UP BY APPLICANT)

REGIONAL GOVERNOR EY 2024: (TO BE FILLED UP BY THE GOVERNOR) MEMBER CONTROL NO.

Eagle GILMAR P. PARADO

REG. GOVERNOR SIGNATURE APPLICANT’S SIGNATURE

INSTRUCTION:

ENDORSED BY: CHAIRMAN MEMBERSHIP 49.0 RENEWAL NOT REQUIRED ENDORSEMENT FROM COMMITTEE FOR
(Luzon, Visayas and Mindanao) MEMBERSHIP

50.0 NEW MEMBERHIP APPLICATION SHALL REQUIRES ENDORSEMENT

Eagle ________________________ FROM COMMITTEE ON MEMBERSHIP
NAME & SIGNATURE ABOVE
 TFOE-Form
2 NATIONAL I.D. APPLICATION FORM
NEW MEMBERSHIP / / RENEWAL

NAME (LASTNAME, FIRSTNAME, MIDDLE NAME) CLUB/ REG POSITION

PUIG, BERDIN, DIORDA DKMEC/ CLUB VICE PRESIDENT

HOME ADDRESS:

EMQ3 DOOR7, BAYANI ROAD, FORT BONIFACIO, TAGUIG CITY

MOBILE NO. HEIGHT: WEIGHT: BLOOD RELIGION:
(FEET) (KGS) TYPE:
09456008310 5’6” 74 “B” ROMAN CATHOLIC
CONTACT PERSON IN CASE OF EMERGENCY: CONTACT NUMBER:

MARY JEAN VG PUIG - WIFE 09952333717

BIRTH DATE: BIRTH PLACE:

December 13, 1973 SAN ENRIQUE, ILOILO

CLUB PRESIDENT: (required) SIGNATURE: DATE: REGION:

Jan 10, 2024 STRXXXVI

Eagle Fortunato C. Villagarcia

REGIONAL MEMBERSHIP:(required) SIGNATURE: DATE: REMARKS:

COMMITTEE FOR MEMBERSHIP: SIGNATURE: DATE: REMARKS:

(LUZON, VISAYAS & MINDANAO)

Eagle ________________________

CLUB AFFILIATED: (TO BE FILLED UP BY APPLICANT)

REGIONAL GOVERNOR EY 2024: (TO BE FILLED UP BY THE GOVERNOR) MEMBER CONTROL NO.

Eagle GILMAR P. PARADO

REG. GOVERNOR SIGNATURE APPLICANT’S SIGNATURE

INSTRUCTION:

ENDORSED BY: CHAIRMAN MEMBERSHIP 51.0 RENEWAL NOT REQUIRED ENDORSEMENT FROM COMMITTEE FOR
(Luzon, Visayas and Mindanao) MEMBERSHIP

52.0 NEW MEMBERHIP APPLICATION SHALL REQUIRES ENDORSEMENT

Eagle ________________________ FROM COMMITTEE ON MEMBERSHIP
NAME & SIGNATURE ABOV
 TFOE-Form
2 NATIONAL I.D. APPLICATION FORM
NEW MEMBERSHIP / / RENEWAL

NAME (LASTNAME, FIRSTNAME, MIDDLE NAME) CLUB/ REG POSITION

ARMENDEZ, ADRIAN, SLAVADOR DKMEC/ CLUB ADVISER

HOME ADDRESS:

B5928 KUWAYO ST., CLARK AIRBASE, PAMPANGA

MOBILE NO. HEIGHT: WEIGHT: BLOOD RELIGION:
(FEET) (KGS) TYPE:
09164211417 5’9” 80 “O+” ROMAN CATHOLIC
CONTACT PERSON IN CASE OF EMERGENCY: CONTACT NUMBER:

SHIELALA L ARMENDEZ - WIFE 09158850339

BIRTH DATE: BIRTH PLACE:

AUGUST 07, 1980 URDANETA CITY

CLUB PRESIDENT: (required) SIGNATURE: DATE: REGION:

Jan 10, 2024 STRXXXVI

Eagle Fortunato C. Villagarcia

REGIONAL MEMBERSHIP:(required) SIGNATURE: DATE: REMARKS:

COMMITTEE FOR MEMBERSHIP: SIGNATURE: DATE: REMARKS:

(LUZON, VISAYAS & MINDANAO)

Eagle ________________________

CLUB AFFILIATED: (TO BE FILLED UP BY APPLICANT)

REGIONAL GOVERNOR EY 2024: (TO BE FILLED UP BY THE GOVERNOR) MEMBER CONTROL NO.

Eagle GILMAR P. PARADO

REG. GOVERNOR SIGNATURE APPLICANT’S SIGNATURE

INSTRUCTION:

ENDORSED BY: CHAIRMAN MEMBERSHIP 53.0 RENEWAL NOT REQUIRED ENDORSEMENT FROM COMMITTEE FOR
(Luzon, Visayas and Mindanao) MEMBERSHIP

54.0 NEW MEMBERHIP APPLICATION SHALL REQUIRES ENDORSEMENT

Eagle ________________________ FROM COMMITTEE ON MEMBERSHIP
NAME & SIGNATURE ABOV