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INSTITUTE OF ELECTRONICS ENGINEERS OF THE PHILIPPINES, INC.

SUITE 712 CITYLAND SHAW TOWER COR. ST. FRANCIS ST. MANDALUYONG

THE ACCREDITED PROFESSIONAL ORGANIZATION IN THE PHILS. (I-APO NO. 05)


TEL.NOS. 687-7187 TELEFAX NO. 687-1676
e-mail add.: iecepsecretariat@yahoo.com website: www.iecep-ph.org

MEMBERSHIP FORM
MEMBERSHIP NO.
NEW (

CHAPTER AFFILIATION

RENEWAL (

ASSOCIATE (

LIFE (

UPDATE (

NAME:
(Surname)

LICENSE NO. (

PECE

ECE

(First Name)

ECT)

(Ext)

DATE OF EXAM:

(Middle Name)

PRC ID VALIDITY:
(MM/DD/YEAR)

BLOOD TYPE:

BIRTHDATE:

PLACE OF BIRTH:
(MM/DD/YEAR)

HOME ADDRESS:
ZIP CODE:
TELEPHONE NO.

MOBILE NO.

EDUCATIONAL ATTAINMENT:
DEGREE

SCHOOL

YEAR

JOB POSITION:
BUSINESS NAME:
BUSINESS ADDRESS:
TELEPHONE NO.

FAX NO.

FIELD OF EXPERTISE: (YOU MAY TICK MORE THAN 1)


Academe
Broadcasting
Construction
Consultancy
Computers
Php 9,999 & below
SALARY RANGE:
Php 40,000 - 49,999
CATEGORY

NAME OF EMPLOYER

Electronics
Government
Information Technology
Management
Manufacturing
Php 10,000 - 19,999

Military
Power Sector
Semiconductor
Telecommunication
Others
Php 20,000 - 29,999

Php 50,000 - 59,999


JOB POSITION

Php 30,000 - 39,999

Php 60,000 & above


INCLUSIVE DATES

FIELD OF EXPERTISE

SALARY RANGE

RELATED TO
ELECTRONICS
ENGINEERING
NOT RELATED TO
ELECTRONICS
ENGINEERING
EMAIL ADDRESS:

PREFERRED MAILING ADDRESS:

SIGNATURE:

DATE:
IN CASE OF EMERGENCY

NAME OF CONTACT PERSON:


HOME ADDRESS
CONTACT

:
:

FOR IECEP SECRETARIAT USE ONLY


MEMBERSHIP NO.

CGS NO.

OFFICIAL RECEIPT NO.

AMOUNT

TRACKING NO.

BACKDUES

HOME

OFFICE

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