Membership Application Form

Individual Membership Application

To apply for membership, please complete all questions.
Name*

First NameLast Name
CLUB AFFILIATION*
Club Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
BIRTHDATE*

MonthDayYear
Date
AGE
Age
Mobile Number*
Mobile No.Format: +(00)000-0000000.
E-mail*
Membership Type*
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1 year Membership Subscription(3,000.00PHP for each year)

2 year Membership Subscription(5,400.00PHP for each two years)

National Athlete, Coach, Trainer, and Referee(600.00PHP for each year)
feel like doing more?
Amount of Donation
Citizenship*
Country
Check payment to Philippine Squash Academy, Inc. for pick upDeposit to UCPB Current Account No. ‘20167-000218-4’
APPLICATION DATE*

MonthDayYear
Date
Signature*
Should be Empty:

Individual Membership Application