PHILIPPINE RED CROSS

____________________ Laguna Chapter

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CONTACT PERSON & NUMBER Effectivity: 12:00 noon from the date of registration and date of expiration

NAME OF AGENCY/SCHOOL File your claims within 30 days from the date of accident

SCHOOL ADDRESS NO. OF MEMBERS:

OFFICIAL RECEIPT NO. VALID DATE (mm/dd/yy) : EXPIRAY DATE (mm/dd/yy) :

CITY/ MOBILE BIRTHDATE

NO. ID NUMBER LAST NAME FIRST NAME MIDDLE NAME ADDRESS BRGY. MUNICIPALITY NUMBER EMAIL ADDRESS (mm/dd/yy) AGE REMARKS

10

11

12

13

14

15

16

17

18

19

20
* Recruitment- Walk-In, Red Cross Training Program, Affiliated School, Affiliated Govt Agency, Affiliated Private Organization Address: J. De Leon St. Cor. P Guevara Ave. Sta. Cruz Laguna

** Classification- Classic (Php. 60.00), Bronze (Php. 150.00), Silver (Php. 300.00), Gold (Php. 500.00), Platinum (Php. 1,000.00), Senior (Php. 300.00), Senior Plus (Php. 350.00) Email: laguna@redcross.org.ph Tel No. (049) 501-1929/(049) 501-1114