Membership Application

University of San Agustin Pharmacy and Medical Technology graduates who are based outside the Philippines are eligible to apply for USAPMTIAA membership.

Do you know that you can apply for Lifetime Membership and will not need to pay Annual Membership Fee? If you donate at least $300 to the Alumni Endowment Fund, you automatically become a Lifetime Member and you are exempt from paying annual dues. Please contact our Treasurer (Dr. Marlon Torrento) if you want to be a Lifetime Member and Donor to our Alumni Endowment Fund.

Please fill out the Membership Form below and pay the annual membership fee of $25.00 either with check or with credit/debit card.

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Last Name

First Name

Maiden Name (If applicable). Please wite NA if not applicable.

Street Address

City

State/Province

Zip Code

Country

Email Address (Your receipt will be emailed to you.)

Mobile Number

Alternate Phone Number

Degree Earned

Year of Graduation

Other Degrees Earned

Current Job Title

Employer

Employer’s Address

Mode of Payment

Paying with Credit or with Debit Card

You may pay with Credit or with Debit Card through Square or PayPal.

Click on this link if paying through Square.

Click on this link if paying through PayPal.

Paying with Check

If paying by check, please write a check in the amount of $25 payable to USAPMTIAA. Membership will be processed once check is received. Please mail the check to:

Marlon C. Torrento, MD, FACP
USAPMTIAA Treasurer
PO Box 270240
Saint Louis, MO 63127
USA

Thank you for your membership application. Once your membership is approved, the Treasurer will email you a notification.

USAPMTIAA is a 501(c)3 organization. Any donation you send to USAPMTIAA may be tax-deductible. Please consult your accountant.