PHILIPPINE SOCIETY OF INFORMATION TECHNOLOGY EDUCATORS

Region XI-Chapter Membership Code

Application for Membership (for PSITE use only)

Having read all the relevant information about the Society, its purposes, membership qualifications and obligations, I
hereby submit my application for membership in PHILIPPINE SOCIETY OF INFORMATION TECHNOLOGY EDUCATORS. I,
therefore, offer the following information in support of my qualification for membership as:

Individual Member Institutional Member Honorary Member

Name (Family, Given, Middle) Nickname Age

PLEASE PASTE
Position Educational Institution / Company PASSPORT SIZE
PHOTO HERE

Address Tel. No. Fax No. Email Address

IT Subjects / Courses Designed / Conducted No. of Hours /

Subject

Education & Training (College level and above only)

Course(s) & Degree(s) Taken School / University / Institution Year Graduated

Professional Qualifications (Professional License, Government Certification, etc)

Complete Description (no abbreviation) Year Taken

Work Experience (limit to three (3) most recent jobs)

Period Covered Position / Company Name / Address Nature of Business / Immediate
From To Superior’s Position

Other Professionals Memberships / Affiliations (if any)

Home Address Tel. No. Civil Status

Date of Birth Place of Birth Name of Spouse

If accepted for membership, I agree NOTE: PSITE

to comply with the requirements of
the By-Laws, and all regulations
adopted by the Society with full
knowledge of the responsibility
imposed upon me.
___________________________
Signature / Date
Application must be accompanied with a ACCEPTANCE / APPROVAL
Check or Money Order payable to
1. Sponsor’s Name/Signature/Date
PHILIPPINES SOCIETY OF INFORMATION
(Waived for Founding Members)
TECHNOLOGY EDUCATORS
in the amount of:_____________
Remittance will be returned in the event
2. Sponsor’s name/Signature/Date
your application is not approved.
(Waived for Founding Members)
Membership Committee / Date