Application Form For Affiliate Membership 128

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RECON PHILIPPINES, INCORPORATED

PNP CES AUXILIARY GROUP


RECON CLARE 7, Incorporated
DX7RC (144.74 mHz. -0.60)
TIN 411-854-866-000
SEC Registration Number CN0201127790
e-mail address: [email protected]

AFFILIATE MEMBERSHIP
APPLICATION
To the Board of Trustees
RECON CLARE 7

I am Reuel A. Tubongbanua, of legal age, a holder of Amateur Radio


License with amateur & RECON call sign of DW7DYZ / RDN7 - 128 and an
active member of RECON DRAGON 7, Inc is applying for affiliate
membership to this group. I am willing and able to abide honestly and
faithfully the Article of Incorporation and by-Laws of this group including all the
rules and regulations, respect the decision of the general assembly and the
Board of Trustees.

I am presently residing at Prk. Tabunon brgy Banilad,Dumaguete


City Negros Oriental. I am attaching herewith my personal data sheet and
promised that all information stated in my personal data sheet are true and
correct to my best of ability.

Reuel A. Tubongbanua
(Name and Signature of the Applicant)
January 23, 2017
(Date Signed)

Recommended for acceptance as Affiliate by the Chapter’s


Governor:

Reuel A. Tubongbanua RDN7 - 128


(Name and Call Sign and Signature)
Approved for Affiliation:

_____________________ _______________________
Vice Governor for Administration Vice Governor for Operations
__________________ __________________
Date Signed Date Signed

______________________________
Governor
__________________
Date Signed

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