ILONGGO INTEGRATED ASSOCIATION, Inc. M E M B E R S H I P F O R

ILONGGO INTEGRATED ASSOCIATION, Inc.

M E M B E R S H I P F O R M

Please type your complete name.

Religion

Type of registration: Family (20 NZD) or Single (10 NZD)?

Date of Birth (date/month/year)
Example: 19/02/2024

Email and Phone Number
Example: 0912 123 4567 , [e-mail]

Name of Spouse, Religion, Email, and Phone Number (if applicable)
Example: Juan de la Cruz, Roman Catholic, nzemail@gmail, 0912 345 6789

List of names of children (if applicable) including birthdays (date/month/year).
Example:
Juan Luna - 20/02/2000
Andres Bonifacio - 23/03/2019
Claro Recto - 07/05/1999

New Zealand Home Address

Philippine Hometown Address

Declaration:

I do hereby declare that I voluntarily join the Ilonggo Integrated Association, Inc. I do believe in its

principles and aspirations and will obey its Charter provided they are not inconsistent with the Incorporated

Societies Act or general laws of New Zealand. My personal details are governed by the Privacy Act of New

Zealand and no portion of it shall be shared to the public without my consent unless it is in pursuance to the

interest of the Association.

Note: Draw or put your signature in the space provided and the date you signed it.