Rm 218 National Engineering Center, UP Diliman, Quezon City, Philippines 1001 Telephone Number: 926.54.87 | Email: [email protected]
NOMINATION FOR MEMBERSHIP
Date______________________
1. Name in Print: Dr/Mr/Mrs/Ms_______________________________________________________________
2. Home Address__________________________________________ Tel. No ___________________________
3. Affiliation/Address________________________________________ Designation_____________________
4. Mailing Address_________________________________________ Tel. No ___________________________
E-mail Address ________________________________________Mobile Phone # _____________________
5. Date and Place of Birth_____________________________________________________________________
6. Educational Background (Degree/s (College/Universities/Dates)
___________________________________________________________________________________________
___________________________________________________________________________________________
7. Branch of science interested in_____________________________________________________________
8. Technical/research papers published indicating title of article, authors, volume, pages, date and the name of the journal. Use additional sheets if necessary.
___________________________________________________________________________________________
___________________________________________________________________________________________
9. Actual research projects in progress________________________________________________________
10. Membership in scientific or professional organizations________________________________________
____________________________________________________________________________________________
Recommended by:
Name: ___________________________
Address: ___________________________
___________________________
Action taken:
Approved ( )
Disapproved ( )
Remarks: If accepted, I am willing to pay* the following:
Initiation Fee: - P 50.00
Annual Dues: Member - P 200.00 Life Member - P2,000.00
Honorary Fellow - (no fee. by conferment)
______________________________________
Signature over printed name
*Membership fee may be deposited to any Metrobank branch: Account Name: Philippine Association for the Advancement of Science and Technology; Checking Account No.: 658-7658020567. Copies of the deposit slip and nomination form may be sent to [email protected] or [email protected]
