EmailMe Form - Filipino Community of York

Name
First Last
Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
Contact number
Email
Date of Birth
MM / DD / YYYY
Sex
Male
Female
Civil Status
Single
Married
Divorced/Separated
Widow
Name of Spouse
First Last
Children
Date of Birth
MM / DD / YYYY
Date of Birth
MM / DD / YYYY
Date of Birth
MM / DD / YYYY
Date of Birth
MM / DD / YYYY
Profession
Name of Employer
Declaration
I certify that all of the information provided in this document are true to the best of my knowledge, were given voluntarily and not in any way obtained under duress, in application for membership to the Filipino Community of York. I understand that the information will only be used in the interest of said Organization, and in accordance with the provisions of the 1998 Data Protection Act, will not be made available to any party without my express consent.
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