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Application for Membership

Buklod follows a strict confidentiality policy on information submitted to us. All data gathered from this page will be used for internal purposes only, and we agree not to disclose or distribute these to any third party, without your prior approval.

If you wish to submit a hardcopy of this application form or send copies to your relatives and friends who may want to apply for membership in Buklod, a downloadable PDF version is available. Please click here to download.

An asterisk (*) indicates a required field.

NAME

Surname (*)
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Given Name (*)
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Middle Name
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DATE OF BIRTH

Year (yyyy) (*)
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Month (mm) (*)
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Day (dd) (*)
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ADDRESS

No./Street/District (*)
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Barangay (*)
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Town
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Province/City (*)
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Congressional District No. (i)
(i) If Province/City has more than one Congressional
district; if not, leave blank
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COMMUNICATION CONTACT DETAILS

Telephone; cellphone; or both (*)
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Email (*)
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OCCUPATION (choose one) (*)

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EDUCATIONAL ATTAINMENT (choose one) (*)

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PROFESSIONAL QUALIFICATION (choose one) (*)

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PARTY ACTIVITIES

Check one or more if you want to directly engage in Buklod activities

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(Note: Assignments will be voluntary, and generally of short-duration and may be done outside of regular work hours.)
DUES (*)

If you can afford paying P100 as membership dues, please indicate so below and we will send you a bill. If you cannot afford it, it is alright; do not bother; you are welcome to Buklod.

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MEMBERSHIP CARD (*)

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CERTIFICATION (*)

Those who have been convicted of any crime or engaged in graft and corruption; and those past and present elected or appointed national or local government official need not apply.
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*Those who have been convicted of any crime or engaged in graft and corruption; and those past and present elected or appointed national or local government official need not apply.

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