MR. PILIPINO

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APPLICATION FOR MEMBERSHIP*

Instructions:
Download the form (PDF format) and mail to:
MR. PILIPINO**
P.O. Box 271142
Tampa, Florida, U.S.A.
33688

-or-
Fill out the on-line form below

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FIRST NAME:		MIDDLE NAME:
LAST NAME:
ADDRESS:		CITY:
STATE:		ZIP:
COUNTRY:
EMAIL:
HOME PHONE:		WORK:
MOBILE PH:		FAX:
DOB:		SEX:
PLACE OF BIRTH:
CITIZENSHIP:		IF OTHER, SPECIFY:

If you are a registered voter...

VOTER ID NO. :		PRECINCT NO. :
POLLING PLACE ADDRESS:

*No membership fee, but donations are welcome by mail or online (below). Please make checks payable to MR. PILIPINO.

**A Florida not-for-profit corporation. Its articles of incorporation and bylaws may be viewed in or downloaded from its website www.mrpilipino.org.