Membership Application Form

Individual Membership Application

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

First Name Last Name
CLUB AFFILIATION *
Club Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
BIRTHDATE *

Month Day Year
Date
AGE
Age
Mobile Number *
Mobile No.
E-mail *
Membership Type *
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1 year Membership Subscription ( 3,000.00 PHP for each year )

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

National Athlete, Coach, Trainer, and Referee ( 600.00 PHP for each year )
feel like doing more?
Amount of Donation
Citizenship *
Country
payment option *

Check payment to Philippine Squash Academy, Inc. for pick up Deposit to UCPB Current Account No. ‘20167-000218-4’
APPLICATION DATE *

Month Day Year
Date
Signature *

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Individual Membership Application