Philippine Educational Measurement and Evaluation Association, Inc.

Membership Application Form

Personal Information
Family Name

Title

First Name
Middle Name

[ ] Dr.
[ ] Ms.
[ ] Mr.

Birthdate
Citizenship

Sex

[ ] Female

Place of Birth

[ ] Male

Institutional Affiliation
Position/Designation

Civil Status

Mailing Address

[ ] Single
[ ] Married

Email

[ ] Separated

Contact Numbers

[ ] Widowed

Educational Background
Degree

Major

Specialization

School/Institution

Year
Graduated

Professional Experience

Position/Title

Institution

Nature of Work

Year

Research and Publications (use additional sheets if necessary)

Title of Research/Publication/Article/
Book

Title of Journal/Book
where it was published

Title and Place of Conference where it

was presented

Year

I certify that all the above information is true to the best of my knowledge and that if accepted as member, I shall abide by the by-laws of the PEMEA,
Inc.

Signature

Date

For PEMEA Membership Committee Use Only:

[ ] Approved membership on ____________________ as
Signature of Membership Committee:

Chair :

[ ] Fellow [ ] Associate
[ ] Junior Affiliate

[ ] Affiliate

________________________________

Members: ________________________________
________________________________
Payment Details: Affiliate Member (College graduate) - Php 500.00 with ID
Professionals (w/ atleast MA degree) - Php750.00 with ID
Bank of the Philippine Islands, Account Name: Philippine Educational Measurement and Evaluation Association, Account no.:
004103-0466-32