The printable version is available HERE. ApplicationName of Applicant * First Last Address *Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeAfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiComorosCongo (Brazzaville)CongoCosta RicaCote d\'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor Timur)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambia, TheGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepaNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint VincentSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of AmericaUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamYemenZambiaZimbabweCountry Date of Birth mm/dd/yyyy Phone * Email FamilyMarital Status Please select one.MarriedSingleDivorcedWidowed Spouse's Name Spouse's Date of Birth mm/dd/yyyy Children/DependentsName Full Name Birthdate mm/dd/yyyy Name Full Name Birthdate mm/dd/yyyy Name Full Name Birthdate mm/dd/yyyy Add More... YesNo Name Full Name Birthdate mm/dd/yyyy Name Full Name Birthdate mm/dd/yyyy Name Full Name Birthdate mm/dd/yyyy InformationWould you be interested in being an ACTIVE member? *YesNo Activities Please mark any and all activities that you and your family would like to participate in or support.Dinner DancesCasino Bus TripsSimbang Gabi (Christmas Novena) EventSimbang Gabi SponsorshipCultural Events Agreement I/We understand that upon signing this application, I/We shall be required to pay a two year membership dues of Ten Dollars ($10.00) per family or Five Dollars ($5.00) for a single member applicant. Dues are payable within (15) days of application. I/We further declare that I/We shall abide with the Association’s Constitution and By-Laws, attend the General Assembly meetings and participate and support the activities and events sponsored by the Filipino Association as best as I/We could. (Membership fee has been waived by the current 2016 administration.) Please check the box to indicate your acceptance of the terms of the membership. * Enter Electronic Signature *Type your full name here. VerificationPlease fill out the word below. * This box is for spam protection - please leave it blank
