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Oriental Mindoro Council: Gov. Ignacio ST, Camilmil, Calapan City Tel: (043) - 288-7252

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Boy Scouts of the Philippines

Southern Tagalog Region


ORIENTAL MINDORO COUNCIL
Gov. Ignacio St, Camilmil, Calapan City
Tel: (043)-288-7252

NOMINATION FORM
(For Regular Board Member)

Name ___________________________________________ Nickname _____________________


Date of Birth ________________________ Place of Birth ________________________________
Home Address __________________________________________________________________
Office Address __________________________________________________________________
Contact Nos. Residence _______________ Office ________________ Mobile _______________
Occupation/Profession ___________________________________________________________
Scouting Connections ____________________________________________________________

Scouting Experience (serves as)

Position Activity Year


_______________ ______________________________ __________________
_______________ ______________________________ __________________
_______________ ______________________________ __________________
_______________ ______________________________ __________________
_______________ ______________________________ __________________

Experiences in other fields:


_______________ ______________________________ __________________
_______________ ______________________________ __________________
_______________ ______________________________ __________________
_______________ ______________________________ __________________

Awards/Honor received (BSP & others)


________________________________________________ __________________
________________________________________________ __________________
________________________________________________ __________________
________________________________________________ __________________

Date _________________ Nominated by: ______________________________


Signature over printed name
I certify that I will attend to all the meetings of the
Local Executive Board and other Meetings of the ____________________________________
Committee assigned to me. Position

______________________________
Institution/District
CONFORME:

_____________________________________
Signature over printed name of nominee

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