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2016 MEMBERSHIP FORMMEMBER INFORMATION

Name: Institutional Affiliation: Position: Mailing address:

Landline Number: Mobile Phone Number:

Primary email address: Secondary email address:

EDUCATIONAL BACKGROUNDDegree Major Institution Year

RESEARCH INFORMATIONResearch interests:

Membership in other professional associations:

MEMBERSHIP CATEGORYPlease tick the membership category applicable to you:☐ One year membership for undergraduate students (PhP 800)☐ One year membership for regular members, including graduate students (PhP

1,000)☐ Three year membership for regular members (PhP 2,700)All members will receive a complimentary copy of Philippine Sociological ReviewSignature: Date:

Membership fees may be paid at the registration desk during the conference or through bank payments to: Philippine Sociological Society, BPI Loyola Branch. Account number 3081084032 (current account). Please enclose a scanned copy of the deposit slip to this form and email to: philippinesociology@gmail.com