MEMBERSHIP CATEGORY: Non-Corporate (Individual)

THE CANADIAN CHAMBER OF COMMERCE OF THE PHILIPPINES

INDIVIDUAL

MEMBERSHIP CATEGORY*

PRINCIPAL ADDRESS*

APPLICANT'S NAME:*

Title

First

Last

Middle

COMPANY NAME & POSITION OR SCHOOL AFFILIATION: *

Address*

Street Address City State / Province / Region Postal / Zip Code Country

TELEPHONE:*

FAX:*

EMAIL ADDRESS:*

NATIONALITY: (Regular)*

TAX IDENTIFICATION NUMBER (TIN):*

BUSINESS / PROFESSIONAL INFORMATION:*

APPLICANT'S PHOTO*

SIGNED INTEGRITY PLEDGE*

The information provided in this application may be used by CanCham for input in all or any of CanCham's searchable databases, membership directories or �鶹��' notices and, as such, may therefore become avialable to the public within or outside of the Philippines. I hereby agree to the release of the data and/or personal information by CanCham for the intended use by CanCham. Please mark your choice:

YES

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APPLICATION FORM

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