Philippine Resume Form - Excel

							                                PHILIPPINE INSTITUTE OF INDUSTRIAL ENGINEERS                                                   Please
                                             G/F Pacific Coast Plaza, Coastal Road, Parañaque City 1701                          Affix
                                      Tel. No. (632) 879-8381 Telefax no. (632) 879-8103 Email: piie@pldtdsl.net                Latest
                                                             Website: http://www.piie.org                                   1" x 1" photo


                                                   MEMBERSHIP APPLICATION

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



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




                     Signature of Applicant / Representative                                   PIIE Membership Chairman