AGUSAN DEL SUR STATE COLLEGE OF AGRICULTURE AND TECHNOLOGY

Bunawan, Agusan del Sur

website: http://asscat.edu.ph
email address: asscatjvg@gmail.com

19084895

MEMBER INFORMATION SHEET

Date of Filing:
Organizational Information
Name of Organization/s: Type of Organization:
1. T-1 College Organization ID Picture
2. T-2 Club 1x1
3. T-3 Religious
Recruiter:
Personal Information Ethnicity:
Family Name First Name Middle Name
Birthday: | | College Course
Contact No.: Yr&Major Student ID No.:
Leadership Views Why did you join this organization and how can you help in
achieving its vision and mission?

Certification
I declare that I have examined the information on this form and to the best of my knowledge and belief, it is
true, correct and complete. I further agree to update this statement as required.
Signature of Member: Date:
Note: Observation/s on Member

Committee on Membership Chairperson: Date:

Secretariat Box To be filled in by secretariat
Reviewed by: Recommended by: Approved by:

Date: Date: Date: