Trileg-membership-form.doc

Republic of the Philippines TRISKELION GRAND FRATENITY TRISKELION LAW ENFORCEMENT GROUP Regional Council VIII Eastern Visayas Council P Print legibly. Check appropriate boxes ABBREVIATE.

and use separate sheet if necessary. Indicate N/A if not applicable. DO NOT

PERSONAL INFORMATION ____________________________________________________________ RANK SURNAME FIRST NAME MIDDLE NAME ________________ DATE OF BIRTH

_________________________________________ DESIGNATION

2x2 Picture

_____________________________________________________________ UNIT ASSIGNMENT _____________________________________________________________ Control # _________________ ADDRESS TRILEG Chapter Council N. Leyte S. Leyte _____________________________________ W. Samar Biliran Province CONTACT NUMBER E. Samar N. Samar _____________________________________ ____________________________________ CONTACT NUMBER IN CASE OF EMERGENCY NAME / RELATIONSHIP SCHOOL/COMMUNITY, YEAR JOINED THE FRATERNITY/ SORRORITY ________________________________ NAME OF SCHOOL/COMMUNITY

_________________________________ DATE ENTERED FRATERNITY/SORORITY

________________________________ NAME OF GRAND TRISKELION

_________________________________ SPONSOR CERTIFICATION

CERTIFICATION OF LEGITIMACY: (Kindly attached if any) VOUCHING TRISKELION NAME

CHAPTER

CONTACT NUMBER

I hereby certified that all of the above information are true and correct to the best of my knowledge and capacity. Any wrong information found shall mean cancellation of my application and may give sufficient cause for investigation.

__________________________ Date

_____________________________ Signature over printed name