1. MAKATI MEDICAL CENTER COLLEGE OF NURSING
ALUMNI ASSOCIATION, INC.
A NON-PROFIT, NON-STOCK CORPORATION
4TH FLOOR LIBRAN HOUSE 144 LEGASPI CORNER V.A. RUFINO ST. LEGASPI VILLAGE MAKATI CITY 1220
MEMBERSHIP FORM
ALUMNI CLASS (YEAR) CITIZENSHIP GENDER BIRTHDAY (MM/DD/YYYY)
FEMALE
FIRST NAME MIDDLE NAME/MAIDEN NAME
LAST NAME NICKNAME:
CIVIL STATUS EMAIL ADDRESS MOBILE LANDLINE FAX
Single
Married PERSONAL
Widow/er
Other
BUSINESS
HOME ADDRESS
COMPANY POSITION
EDUCATIONAL BACKGROUND
YEAR GRADUATED DEGREE COLLEGE
Place Electronic Signature anywhere here
contained herein are free and harmless from any liability arising from the use of any such information.
I affirm that the information entered in this document is true and correct; and that the obtained, disclosed, or verified information
COLLEGE
Makati Medical Center College
GRADUATE SCHOOL
If you have not/ did not finished a degree, please indicate the college, level, and years of stay (e.g. AB Psych 3rd year, 1996 – 1999)
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MEMBERSHIP CATEGORY
WE WELCOME YOU TO MAKATI MEDICAL CENTER COLLEGE OF NURSING ALUMNI ASSOCIATION!
The Association thrives because of the Alumni members’ support through their membership and donations.
As part of the Alumni Association, you will receive benefits that are continuously growing!
FEES VALIDITY
Student Alumni Associate P 100 1 year
Provisionary Member P 300 2 years
Renewal/ Old Member P 300 2 years
Replacement (For damage or lost valid P 100 Carried over from the previous card
cards only)
What Membership Category are you applying for?
Renewal
How do you want to receive your Alumni ID Card?
Pick-up
Delivery Fees
(deliverables are sent via registered mail)
⃝ Within the Philippines? ⃝ Outside the Philippines?
P 100 P 200
Delivery Address:
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