Subject: Application for Regular Membership

Similar documents
complete the required information. Internet access is provided in our office, if needed.

Each successful applicant is awarded RM 2,000 per year for their education fees. The amount will be disbursed twice a year.

SANTA BARBARA POLO & RACQUET CLUB

STEPS FOR COMPLETING THE SERVICE LEARNING PACKET PLEASE READ ALL of the information contained in this document carefully.

THE CAMERON HIGHLANDERS OF OTTAWA BURSARY APPLICATION FORM

Application for: Short Programme. Nelson Mandela Metropolitan University: 20. Prog. 1. Name: Prog. 2. Name:

CITY OF GLADSTONE APPLICATION FOR EMPLOYMENT (An Equal Opportunity Employer)

Student Admission Application Form

ASSOCIATE MEMBERSHIP ORTHOPAEDIC

Application for Teacher s Certificate of Qualification

VOLUNTEER SERVICES APPLICATION (Must be 16 years of age or older.)

Name of Sex: M F Applicant: Last First Middle. Date of Birth: Social Security Number: Phone: ( ) City State Zip. Phone: ( ) City State Zip

VERMILLION COUNTY SHERIFF'S OFFICE

U.S. Dependent Scholarship Program

Thank You for your interest in joining our TEAM!

application to Katherine Gulotta at DEADLINE TO APPLY IS JANUARY 31. Date of Birth Place of Birth Gender

Network Participant Credentialing Application

AMERICAN OSTEOPATHIC BOARD OF FAMILY PHYSICIANS (AOBFP) 330 E. Algonquin Rd., Suite 6 Arlington Heights, IL

GENERAL APPLICATION FOR EMPLOYMENT

Texas Credit Union Department page 1 of 2 VOLUNTEER APPLICATION and AGREEMENT TO SERVE

Employment Application NOTICE OF POLICY

Calhoun County Sheriff s Office. Sheriff Thomas Summers Jr. Employment Application

Application for Temporary Authorization Original OR Renewal (Instructional)

7547 Main Street John R. Williams, Jr. Sykesville, Maryland Police

ALLIED HEALTH PROFESSIONAL CREDENTIALING APPLICATION FORM

Registration and Licensure as a Pharmacy Technician

AIT APPLICATION PACKAGE FOR REGISTRATION AS A PSYCHOLOGIST OR PSYCHOLOGICAL ASSOCIATE Version

PLEASE TYPE OR PRINT CLEARLY USING A PEN. Today s Date:

WEST VIRGINIA BOARD OF PHYSICAL THERAPY 2 Players Club Drive, Suite 102 Charleston, West Virginia Telephone: (304) Fax: (304)

APPLICATION CHECKLIST IMPORTANT

CREDENTIALING APPLICATION Please complete all sections. Incomplete applications may delay the credentialing process.

Pennsylvania State Board of Barber Examiners

APPLICATION FOR EMPLOYMENT Wallace Community College Selma

LivaNova Terms and Conditions for Donations and Grants

REFERENCES: (If applying to assist with religious activities, please include a member of the clergy as a reference.)

Langston University Returning Athlete Screening Form

APPLICATION FOR EMPLOYMENT

COUNTY OF YOLO OFFICE OF THE DISTRICT ATTORNEY JEFF W. REISIG, DISTRICT ATTORNEY CITIZENS ACADEMY APPLICATION PROCESS

WI Procedures for Applying for Examination (Work Experience Instructor Candidate)

CREDENTIALING PROCEDURES MANUAL MEMORIAL HOSPITAL OF SOUTH BEND, INC. SOUTH BEND, INDIANA

A. LICENSE BY EDUCATION

Last Name: First Name: Middle Name: Street Address: City: State: Zip Code: Home Phone: Work Phone: Cell Phone: May We Call You at Work?

GENERAL APPLICATION FOR EMPLOYMENT Human Resources City of New Smyrna Beach 210 Sams Avenue New Smyrna Beach, Florida 32168

APPLICATION FOR HEALTH PROFESSIONAL LICENSURE

SCORPION BURSARY FORM. form to UJ BURSARY/STUDENT FINANCE

Vermont Board of Nursing INSTRUCTION TO APPLICANTS FOR LICENSURE

!! PLEASE WRITE VERY CLEARLY TO AVOID PROCESSING DELAYS!!

INSTRUCTION TO APPLICANTS A. ADMINISTRATOR IN TRAINING PROGRAM:

Application for Certification as a Groundwater Professional National Ground Water Association

Provider Rights. As a network provider, you have the right to:

Credentialing Application

PLYMOUTH POLICE DEPARTMENT POLICE OFFICER EMPLOYMENT POLICIES

LIBERTY DENTAL PLAN. Dental Hygienist - Credentialing Application. City: State: DEGREE: City: State: DEGREE:

Adams County Court for Veterans Mentoring Program Information Sheet

Osage Nation Child Care 239 W. 12 th Street Pawhuska, Oklahoma (918) phone (918) fax CHILD CARE PROVIDER APPLICATION

USABLE CORPORATION TRUE BLUE PPO NETWORK PRACTITIONER CREDENTIALING STANDARDS

APPLICATION CHECKLIST IMPORTANT Submit all items on the checklist below with your application to ensure faster processing.

Application for Reactivation of a Licence in Nova Scotia

2018 Terms and Conditions for Support of Grant Awards Revised 7 th June 2018

BCBS NC Blue Medicare Credentialing Instructions

Upper Bay Counseling & Support Services, Inc. 200 Booth Street, Elkton, MD Phone: Fax: Name: Last First Middle

Registered Nurse Renewal/Reinstatement Application

Oncology Nurse Practitioner Fellowship Application

FORM N-100 FOR TANZANIAN LOCAL SUPPLIERS AND SERVICE PROVIDERS (LSSP) DATABASE IN THE PETROLEUM SUBSECTOR

MEDICAL STAFF CREDENTIALING APPLICATION FORM For MD; DO; DDS; DMD; DC; DPM; PharmD; PhD; PsyD; OD.

USE OF VOLUNTEERS IN SCHOOLS

Candidates failing to include ALL required documentation will be disqualified.

COUNCIL OF INTERNATIONAL PROGRAMS USA

SHERIFF OF GARFIELD COUNTY LOU VALLARIO

CITY OF BRANDON POLICE DEPARTMENT APPLICATION FOR EMPLOYMENT. ALL applicants MUST attach items 1, 2, 3, 4 I. PERSONAL HISTORY

Private Investigator and/or Security Guard Qualifying Agent Application

Application for Certification as a Groundwater Professional National Ground Water Association

Application Requirements to be considered for Approval:

GUIDELINES FOR BUSINESS IMPROVEMENT GRANT PROGRAM BY THE COLUMBUS COMMUNITY & INDUSTRIAL DEVELOPMENT CORPORATION

Certified Dangerous Goods Trainer Application

ALLEGANY-LIMESTONE CENTRAL SCHOOL DISTRICT APPLICATION FOR SUPERINTENDENT OF SCHOOLS PERSONAL INFORMATION

Registered Nurse Renewal Application

High School Internship Program for Diverse Students

SENATE, No STATE OF NEW JERSEY. 216th LEGISLATURE INTRODUCED APRIL 28, 2014

Sign and return included forms. (Authorization to Release Information Form, Background Check Form and Vehicle Use Agreement)

Application Packet for 2017 Summer Youth Employment Program

Dunia. Young Leaders Scholarship Program. Application Form. Empowering people, Enabling success, Enriching lives

LETTER OF UNDERSTANDING

LIBERTY DENTAL PLAN. Provider Credentialing Application. (* Required Fields) *OFFICE PHONE #: ( ) EMERGENCY PHONE #: ( ) *FAX #: ( )

Legal Last Name First Middle Professional Title/Degree

Bursary Application Form 2016

ACADIA PARISH SHERIFF S OFFICE K.P.GIBSON Sheriff and Ex-Officio Tax Collector JOB APPLICATION FORM

Thank you very much for your interest in volunteering for Make-A Wish Minnesota! Becoming a volunteer is easy, just complete these steps:

APPLICATION FOR AIRPORT RESTRICTED AREA PASS ALL INFORMATION TO BE ENTERED IN BLOCK CAPITALS

THE PSYCHOLOGICAL ASSOCIATION OF MANITOBA L ASSOCIATION DES PSYCHOLOGUES DU MANITOBA

Applicants for Licensure as a Marriage and Family Therapist. Steps for Applicants Applying by Examination:

MT. WASHINGTON FIRE PROTECTION DISTRICT 772 NORTH BARDSTOWN ROAD MT. WASHINGTON, KY

Employee Registration Information

St Johns Unified School District #1

Licensed Nursing Assistant Renewal/Reinstatement Application

PRACTICE INFORMATION AND LETTER AGREEMENT FORM. COMPLETE, SIGN AND RETURN TO: One Huntington Quadrangle Suite 1N09 Melville, NY 11747

DEPENDENT SCHOLARSHIP PROGRAM

Grand Prairie Fire Department Applicant Identification Form

(907) PHONE (907) FAX

HOISINGTON POLICE DEPARTMENT 109 E. 1 st St. Hoisington, KS Telephone (620) Fax (620)

Transcription:

THE BOARD OF DIRECTORS Baguio Country Club Corporation Country Club Road PO Box 8, Baguio City Gentlemen: Subject: Application for Regular Membership I hereby apply for Regular Membership in the Baguio Country Club Corporation. I am fully aware that the purchase of a share alone does not qualify me for Regular Membership. I know that I may be elected to Regular Membership only by the action of the Board of Directors which has the exclusive right to accept or reject this application. If accepted, I acknowledge that Regular Membership shall be vested only upon payment of the required membership entrance fee as the Board may determine and upon approval of my Regular Membership. I also acknowledge that if any accounts of transferor have not been paid, I, as transferee-applicant, hereby undertake to pay the Club whatever remaining obligations may have been left unpaid by the transferor. I am aware that membership in the Club is a privilege and not a right and that the Board has the sole and absolute discretion to approve or disapprove my application. I also understand that the Board is not required nor is it under obligation to explain or justify to me or to any party, the reasons for approving or disapproving my application and I undertake not to seek any explanation or justification from the Board or any party, any action/decision made by the Board on my application. I further undertake to hold the Club, its members, officers and directors free and harmless from any claim, liability, suits or similar actions in the event that my application is denied or action thereof is delayed or deferred by the Board. I agree to abide by the Articles, the By-Laws and the Rules and Regulations of the Baguio Country Club, if elected, copies of which have been given to me or made available for my perusal. To support my application, I submit the attached application form completely filled and properly signed by my proposer, seconder and myself. Thank you for your consideration. Signature of Applicant Name in Print Date Signed Attachment: Completed BCC Application Form PAGE 1

APPLICATION FOR REGULAR MEMBERSHIP TO THE BAGUIO COUNTRY CLUB CORPORATION (Please completely fill up the form for proper processing) Family Name First Name Maternal Name Nickname BIRTH INFORMATION Gender: Male ( ) Female ( ) Citizenship City of Birth Province Country Date of Birth (mo/day/yr) Country Immigrated (if applicable) Year of Immigration Civil Status: ( ) Single ( ) Married ( ) Legally Separated ( ) widow/widower PARENTS Father: Last Name First Name Middle Name Mother: Last Name First Name Middle Name MARRIAGE (Current) Spouse s Last Name First Name Middle Name Spouse s Last Name Prior to Marriage Month, Day and Year of Marriage BIRTH INFORMATION City of Birth Province Country Date of Birth (mo/day/yr) Country Immigrated (if applicable) Year of Immigration Citizenship Sports Interests/Hobbies/Socio Civic Activities: CHILDREN S NAMES: Please indicate if Single or Married. A blank space will be considered as married for children 18 years and above. PAGE 2

MARRIAGE (Prior) Spouse s Last Name First Name Middle Name Spouse s Last name Prior to Marriage Month/Day and Year of Marriage CHILDREN S NAMES: Please indicate if Single or Married. A blank space will be considered as married for children 18 years and above. CAREER-RELATED ACTIVITIES 1. Position Name of Organization/Business Nature of Business City/Country From (year) To (year) 2. Position Name of Organization/Business Nature of Business City/Country From (year) To (year) 3. Position Name of Organization/Business Nature of Business City/Country From (year) To (year) SOCIO-CIVIC ACTIVITIES 1. Role Organization Location Year 2. Role Organization Location Year 3. Role Organization Location Year MILITARY RECORD (Active Duty Only) Highest Rank Military Organization/Branch Location Year EDUCATION 1. Earned Degree School City/Country Year Degree Was Received 2. Earned Degree School City/Country Year Degree Was Received 3. Earned Degree School City/Country Year Degree Was Received PAGE 3

HONORARY DEGREES 1. Degree Bestowed Organization City/Country Year 2. Degree Bestowed Organization City/Country Year PROFESSIONAL CERTIFICATION AWARDS, HONORS, GRANTS 1. Award/Honor/Grant Awarding/Honoring/Granting Body Location Year 2. Award/Honor/Grant Awarding/Honoring/Granting Body Location Year CURRENT PROFESSIONAL AND CLUB MEMBERSHIPS 1. Role Organization From (year) To (year) 2. Role Organization From (year) To (year) 3. Role Organization From (year) To (year) AFFILIATIONS Religious Denomination (optional) Political Party (optional) AVOCATIONS ( e.g. hobbies/recreational activities please list up to 5) PSYCHOLOGICAL FITNESS/CAPACITY (details, if any, of treatment and/or confinement for Psychological and/or Psychiatric problems. State NONE if inapplicable.) BANK AND CREDIT REFERENCES Bank Credit Card Credit Limit Granted Bank Credit Card Credit Limit Granted Bank Credit Card Credit Limit Granted a) Have you ever had a cancelled credit facility? ( ) No ( ) Yes Reason: b) Pending civil or criminal case/s against me in the Philippines or abroad. ( ) No ( ) Yes Details: c) Past criminal conviction on the Philippines or abroad. ( ) No ( ) Yes Details: d) Record of disciplinary action from other Clubs. ( ) No ( ) Yes Details: PAGE 4

ADDRESS Residence Address Office Address Street Address Postal Code City Province/Region Country Phone No/s Fax No/s E-mail Address Organization Street Address Postal Code City Province/Region Country Phone No/s Fax No/s E-mail Address Preferred Mailing Address: ( ) Residence ( ) Business I believe I will be an asset to the Club and hope to contribute through the following: Sports Competition Participation ( ) Committee Memberships ( ) Special Events Sponsorship ( ) Others ( ) I have applied for BCC Membership before. I acquired my BCC Stock Certificate from who resigned on ( ) No ( ) Yes When? I certify that all the information given are true and correct of my own knowledge and information and that any material falsehood or inaccuracy shall be basis for the rejection of my application for membership as well as its revocation or recall if already granted. I likewise authorize the BCC expressly to seek verification on any matter related to my disclosure or non-disclosure above to enable it to assess the merits of this application. I will undertake to respect and abide by the Club Rules and Regulations and all future amendments thereto which, the Club may from time to time amend. Signature of the Applicant: Date: ****************************************************************************** I hereby affirm that the above applicant is personally known to me and consider him/her in every way a desirable member for the Baguio Country Club. Proposer s Signature: Seconder s Signature Printed Name: Printed Name: Membership No: Membership No: Date Signed: Date Signed: PAGE 5

NOMINATION FORM OF CANDIDATES Date: THE MEMBERSHIP COMMITTEE Baguio Country Club Corporation Gentlemen: We desire to nominate as Candidate for Membership: First Name Surname Middle Name Title/Rank Nationality (if naturalized, please state nationality at birth) Private Residence Address and Telephone No/s TO BE COMPLETED BY THE PROPOSER 1. How many years have you known the candidate? 2. Does your knowledge of the Candidate arise from: a) Personal Friendship b) Professional Relations c) Business Relations 3. If you know of five (5) Club Members who is known personally to the candidate and who may support the application. Names: 4. Please give additional information to enable the Committee and the Board of Directors to judge whether the candidate would be a fit and financially responsible member. PAGE 6

TO BE COMPLETED BY THE SECONDER 1. How many years have you known the candidate? 2. Does your knowledge of the Candidate arise from: a) Personal Friendship b) Professional Relations c) Business Relations 3. If you know of five (5) Club Members who is known personally to the candidate and who may support the application. Names: 4. Please give additional information to enable the Committee and the Board of Directors to judge whether the candidate would be a fit and financially responsible member. WE HEREBY CERTIFY THAT THE ABOVE APPLICANT IS KNOWN TO US AND THAT WE CONSIDER HIM/HER IN EVERYWAY A DESIRABLE MEMBER OF THE BAGUIO COUNTRY CLUB CORPORATION. Proposer s Signature: Printed Name: Membership Number: No. of Years of Membership in BCC: Date Proposed: Seconder s Signature: Printed Name: Membership Number: No. of Years of Membership in BCC: Date Proposed: PAGE 7

The Board of Directors Baguio Country Club Corporation Country Club Road Baguio City 2600 Gentlemen: I hereby confirm that I have sold/donated/transferred my share covered by Certificate Number to Mr/Ms subject to the provisions of the Club s Articles and By-Laws and existing rules and regulations. Please consider therefore my Membership as resigned or terminated effective the end of the month. I assume payment on all dues, accounts, patronage fees, penalties and other assessment with the Club including cost of collection, attorney s fees (if any) and acknowledge the non-settlement of the same shall constitute a lien on my share of stock in favor of the Club and will adversely affect the application of the buyer/donee/transferee. I understand that no share of stock against which the Club holds any unpaid claim shall be transferable in the books of the Club. I finally surrender my card and that of my dependents and authorize the Club to immediately cancel our signing privileges. Name of Member Membership Number Certificate Number Address PAGE 8