JANIUAY ASSOCIATION IN NORTH AMERICA

MEMBERSHIP APPLICATION

Contact Information

JANIUAY ASSOCIATION IN NORTH AMERICA
41 SWEETGUM LANE, MILLER PLACE , NY 10022
TEL. NUM: (631)662-2312
EMAIL: Janiuay@gmail.com

Full Name: *

(first, middle, last name)

Email:

Alternate Email:

Home Phone #:

( )

Cell Phone #:

( )

U.S.A. & Canada Address

Street Address

Address continued

City

Zip

Prov/State(Canada Residence)

State (U.S. Residence)

Philippines Address

Street Address

Address continued

Town

City

Zip

Phone #:

( )

+63 country + 33 Iloilo code

phone number

Other Countries Address

Street Address

Address continued

City

Zip

State/Region

Country

Phone #:

( )

country + area code

phone number

Please Check

Born in Janiuay

Mother, Father or spouse is/are native/s of Janiuay

Honorary Member

Janiuay Ancestry

Membership

I would like to become a member of Janiuay Association in North America for 2008-2009. Thank you. (Please select the button)

_______________________________________________________________

Pinalangga nga Kasimanwa,

To be a member of the Janiuay Association In North America your contribution of $20.00 (membership) per person is very much appreciated . You can call at (631)662-2312 to arrange payment or mail to this address.

JANIUAY ASSOCIATION IN NORTH AMERICA
41 SWEETGUM LANE, MILLER PLACE , NY 10022, U.S.A.

Ma-email o matawag kami kanimo sa mga sunod nga inadlaw.

Salamat gid,

Ruperto 'Pertz' Villadarez

Public Relations Officer

Your personal message *

Please write anything about yourself, any suggestions to our association and a short messsage for all our Kasimanwa world wide.

Need assistance with this form?

JANIUAY ASSOCIATION OF NORTH AMERICA