Regional Elimination
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P PHILIPPINE I I NSTITUTE OF C CIVIL E ENGINEERS, INC . . PARTICIPANT – REGIONAL ELIMINATION Region _________ Venue :_____________________________________________________ Host : ____________________________________________________ Name _________________________________________________________________________________________ (Surname) (First Name) (Middle Initial) School Chapter __________________________________________________________________________ Address _______________________________________________________________________________________ Current Year ___________________________________________________________________________________ Position in School Chapter _________________________________________________________________________ School Contact Tel. No. __________________________________________ Fax No. _________________________ School E-mail address ____________________________________________________________________________ PERSONAL DATA: Home Address _______________________________________________________________________________________________ _______________________________________________________________________________________________ Tel. No. _____________________________________________ Fax No. ____________________________________ Cell Phone _________________________________________ E-mail address ________________________________ COACH DATA: (must be an active member of PICE) Name _____________________________________________ Cell Phone __________________________________ E-mail address ____________________________________ Signature ______________________________________ I certify that I am currently enrolled and is a bonafide student member of PICE in good standing and have not participated in any Regional Elimination Competition this year. Photocopy of valid school identification Photocopy of school registration ___________________________________ Signature Date __________________________ 2” x 2” PHOTO Note: This form should be fully accomplished and submitted to the PICE National office at least five (5) days before the Regional Elimination. PICE-OPN-FM-01-019/Rev.00/Eff.- Date: June 2, 2014
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Transcript of Regional Elimination
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PPHILIPPINE IINSTITUTE OF CCIVIL EENGINEERS, INC..
PARTICIPANT REGIONAL ELIMINATION Region _________
Venue :_____________________________________________________
Host : ____________________________________________________
Name _________________________________________________________________________________________ (Surname) (First Name) (Middle Initial)
School Chapter __________________________________________________________________________
Address _______________________________________________________________________________________ Current Year ___________________________________________________________________________________ Position in School Chapter _________________________________________________________________________ School Contact Tel. No. __________________________________________ Fax No. _________________________ School E-mail address ____________________________________________________________________________ PERSONAL DATA: Home Address _______________________________________________________________________________________________ _______________________________________________________________________________________________ Tel. No. _____________________________________________ Fax No. ____________________________________ Cell Phone _________________________________________ E-mail address ________________________________ COACH DATA: (must be an active member of PICE) Name _____________________________________________ Cell Phone __________________________________ E-mail address ____________________________________ Signature ______________________________________
I certify that I am currently enrolled and is a bonafide student member of PICE in good standing and have not participated in any Regional Elimination Competition this year.
Photocopy of valid school identification
Photocopy of school registration
___________________________________
Signature
Date __________________________
2 x 2
PHOTO
Note: This form should be fully accomplished and submitted to the PICE National office at least five (5) days before the Regional Elimination.
PICE-OPN-FM-01-019/Rev.00/Eff.- Date: June 2, 2014
