Membership Application Form (Individual)

THE CANADIAN CHAMBER OF COMMERCE OF THE PHILIPPINES

INDIVIDUAL

MEMBERSHIP CATEGORY*

PRINCIPAL ADDRESS*

APPLICANT'S NAME:*

Title

First

Last

Middle

COMPANY NAME & POSITION OR SCHOOL AFFILIATION: *

Address*

Street Address City State / Province / Region Postal / Zip Code Country

TELEPHONE:*

FAX:*

EMAIL ADDRESS:*

NATIONALITY: (Regular)*

TAX IDENTIFICATION NUMBER (TIN):*

BUSINESS / PROFESSIONAL INFORMATION:*

APPLICANT'S PHOTO*

SIGNED INTEGRITY PLEDGE*

The information provided in this application may be used by CanCham for input in all or any of CanCham's searchable databases, membership directories or events' notices and, as such, may therefore become avialable to the public within or outside of the Philippines. I hereby agree to the release of the data and/or personal information by CanCham for the intended use by CanCham. Please mark your choice:

YES

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