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Piep Membership Application Form New - 1

This document is a membership form for the Philippine Institute of Environmental Planners. It requests contact details, education and employment history, areas of expertise, and training. The applicant agrees to provide truthful information and consents to their inclusion in a membership directory. They express interest in becoming a member by enclosing payment of membership fees. The form is then evaluated by the PIEP Membership Committee.

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Goldwin Ruben de Castro
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215 views

Piep Membership Application Form New - 1

This document is a membership form for the Philippine Institute of Environmental Planners. It requests contact details, education and employment history, areas of expertise, and training. The applicant agrees to provide truthful information and consents to their inclusion in a membership directory. They express interest in becoming a member by enclosing payment of membership fees. The form is then evaluated by the PIEP Membership Committee.

Uploaded by

Goldwin Ruben de Castro
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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PHILIPPINE INSTITUTE OF ENVIRONMENTAL PLANNERS

G/F School of Urban and Regional Planning Bldg.


University of the Philippines, Diliman, Quezon City, Philippines
TeleFax: 920-9705 │Email: [email protected]

MEMBERSHIP FORM  Old


Member
Section I: CONTACT DETAILS  New
Member
Full Name

Residential Address

Office Address

Fax / Telephone Number

Mobile Number

Email

Date of Birth (mm/dd/yy) PRC license No. Year Obtained

Section II: EDUCATION


School Degree / Certificate obtained Date obtained

Other Professional Certification

Section III: EMPLOYMENT: Work experience for the most recent 3 years

Employer / Project Position Period of Employment

Section IV: INDUSTRY: Check all that apply

 Academe  Government: National Agency

 Private Practice / Firm  Government: Local

 Consultancy  Development Work (including I/NGOs)


 Others: please specify
__________________________________________________________________________________
Section V: FIELDS/ AREAS OF EXPERTISE: Check all that apply

 Land Use Planning  Economics

 Infrastructure / Utilities Planning  Statistics

 Transportation Planning  Law / Legal Administration

 Institutional Planning  GIS / Mapping

 Environment / Natural Resources Planning  Architecture

 Heritage Planning  Engineering

 Tourism Planning  Sociology / Social Sciences

 Estate Planning  Climate Change / Disaster Risk Reduction


 Others: please specify
__________________________________________________________________________________
Section VI: TRAININGS / SEMINARS

Title of Training/Seminar Year

Section VII: MEMBERSHIP IN OTHER ORGANIZATIONS

Organization and Position Year

Please check if you agree with the following statements:

 I agree and certify that to the best of my knowledge that the information I provided is truthful and accurate.

I agree and give my consent to PIEP to include the information I provided herewith in its directory to be published
and circulated with the general membership

 I hereby express my interest to be a member of the Philippine Institute of Environmental Planners. Enclosed is the
amount of ___________ to serve as payment for membership fees.

Name and Signature of Applicant Date

PIEP MEMBERSHIP COMMITTEE’S ACTION (Please check):

Date Evaluated _________________

 Accepted as ( regular / associate / affiliate ) member


 Action deferred due to
_________________________________________________________________________
 Decline due to
_______________________________________________________________________________

REMARKS:
______________________________________________________________________________________

MEMBERSHIP COMMITTEE:
Chairman __________________
Members __________________

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