POLYTECHNIC UNIVERSITY OF THE PHILIPPINES ALUMNI ASSOCIATION, U.S.A., INC. (PUPAA-USA)

POLYTECHNIC UNIVERSITY OF THE PHILIPPINES ALUMNI ASSOCIATION, U.S.A., INC. (PUPAA-USA)
www.pupalumniusa.org

Tel. No. (424)361-5252 Fax (424)361-5253
MEMBERSHIP APPLICATION FORM
Name (First-Middle-Last)
Maiden Name
Mailing Address
Tel No.
Home
Work
Email Address
example@example.com
Social Media Accounts:
Birthday

MonthDayYear
Date
Attended PCC/PUP:
High School
High School Campus Location
College
Degree (Undergraduate)
College Campus Location
Faculty
Faculty Campus Location
School Affiliations
(Fraternity/Sorority/Social Clubs)
FAMILY:
Spouse
No. of Children/Name(s)/Age(s)
No. of Grandchildren/Name(s)/Age(s)
WORK:
Employer
Position
Retired/Year
SOCIAL
Organizations/Positions,
Awards Received/Year
Activities
Hobbies
Talents
Membership Dues
Annual Dues: $25.00
Lifetime Dues: $250.00
Payment:

1. Make check payable to PUPAA-USA

Mail to: PUPAA, U.S.A., Inc., 10530 Venice Blvd., Culver City, CA. 90232

2. Zelle is also available. Please ask for details.

3. Credit Card payment is currently unavailable.
Security of Personal Information:PUPAA-USA will protect the confidentiality of the personal information you provided and will not share nor use in any form of direct marketing or sales to third parties.
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MEMBERSHIP APPLICATION FORM