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Piie Membership Form

This document is a membership application for the Philippine Institute of Industrial Engineers. It requests information such as the applicant's name, date of birth, contact details, employer information, preferred mailing address, type of membership being applied for, annual membership fees, preferred committee, and signatures of the applicant and PIIE Membership Chairman. The types of membership include individual, industry, academe, student chapter, and institution at various fee levels.

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328 views1 page

Piie Membership Form

This document is a membership application for the Philippine Institute of Industrial Engineers. It requests information such as the applicant's name, date of birth, contact details, employer information, preferred mailing address, type of membership being applied for, annual membership fees, preferred committee, and signatures of the applicant and PIIE Membership Chairman. The types of membership include individual, industry, academe, student chapter, and institution at various fee levels.

Uploaded by

bhen422
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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PHILIPPINE INSTITUTE OF INDUSTRIAL ENGINEERS

G/F Pacific Coast Plaza, Coastal Road, Paraaque City 1701 Tel. No. (632) 879-8381 Telefax no. (632) 879-8103 Email: [email protected] Website: http://www.piie.org

Please Affix Latest 1" x 1" photo

MEMBERSHIP APPLICATION
Name: Mr. / Ms. Last Date of Birth: Home Address: Preferred Mailing Address for PIIE Correspondence (check one) Title / Department / Position: Employer: Address: City / State / Province: Phone Number: E-mail Address: For Institutional Membership (Allowed to have one Alternate member) Name of Alternate Representative: Position: Address: Phone Nos.: Requirements: 1. Resume of Applicant / Representative 1. Type of Membership (Please check applicable status) Individual / Industry [ ] Academe Student Chapter Institution P1,200.00 P0,750.00 P0,500.00 Mode: Cash [ ] [ ] [ ] - individual member rate for those whose institution is a member - individual member rate / professor whose institution is a member - individual member rate / student within one year after graduation Check Bank Name: Check # Amount O.R. # 2. Annual Membership Fees Amount P1,500.00 P1,000.00 P1,500.00 P3,500.00 Fax No.: E-mail Address: Home: Office: Cellphone No.: Fax: First Nickname: Home Work Middle Initial

Preferred Committee: [ ] Programs (GMMs) [ ] Membership (Industry / Academe) [ ] Student Chapter [ ] Publications [ ] Amendements [ ] Professional Development [ ] Promotion [ ] Certification / Technical [ ] Ways and Means [ ] National Congress [ ] Fellowship

Signature of Applicant / Representative

PIIE Membership Chairman

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