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*boxes with check apply those who can join the event Years Affiliation Fee 1 750 2 1,300 3 1,900 4 2,440 5 3,050 EVENTS Affiliates Non- Affiliates Save! E E l l e e m m e e n n t t a a r r y y S S c c h h o o o o l l H H i i g g h h S S c c h h o o o o l l T T e e a a c c h h e e r r s s National Science Clubs Summit 250 1000 750 I Teach Science Seminar 250 1000 750 PSYSC Science Olympiad FREE! Exclusive for PSYSC Affiliates Summit-MathSciAKa (Engineering Science and Interactive Workshops) MathSciAKa (Luzon-based) Search for the Most Outstanding Science Club National Childrens Science Interactive Workshop 5000 8000 3000 National Youth Science Technology and Enviroment Summer Camp 5500 8500 3000 Frequently Asked Questions (FAQs) Who can be affiliates of PSYSC? All science clubs from public and private elementary and high schools. How much is the affiliation fee? The matrix below shows the affiliation fee corresponding with the number of years of affiliation desired. The longer you affiliate, the more savings you get! What do we get when we affiliate? Assistance to your Local Science Club Activities Students’ and Teachers’ Aids PSYSC Affiliate’s Email Account PSYSC Medal of Excellence for Science Club Leadership Science Club ID and Certificates Exclusive participation in PSYSC Activities and Activity Discounts How many Science Clubs in my school can affiliate? The school can affiliate more than one (1) science club. How many members does the affiliation fee cover? The affiliation fee is good for an unlimited number of members. How do we affiliate? THIS FORM IS FREE OF CHARGE AND MAY BE PHOTOCOPIED. Fill out the PSYSC Information Sheet (Form 1). Print legibly all information required. Pay the Affiliation fee through either: Landbank of the Philippines Acct. No. 0702-1020-65 and send a photocopy of the deposit slip for PSYSC records (kindly present the original copy during PSYSC events for verification purposes) or Postal Money Order payable only to the PHILIPPINE SOCIETY OF YOUTH SCIENCE CLUBS and send the original postal cheque. Fill out the Science Club’s Roster of Members and Advisers (Form 2) and send it to [email protected]. Send the requirements for affiliation through: Any courier services (e.g. Postal Mail, LBC, etc.) address to Unit 703, West Mansions Condominium, Zamboanga Street, Barangay Nayong Kanluran, Quezon City 1104 or Email by attaching the scanned documents and send to [email protected]. Inform us upon sending the requirements in order for us to track where and when the documents were sent. Upon Receipt of Payment, Form 1 and Form 2, your science club will be notified by the Affiliations Committee and the name of your science club will be registered to the PSYSC Database. Your affiliation will start by the time of payment and will end after the number of years you specified to affiliate. Science Club advisers and members can now enjoy the PSYSC benefits! For more information, you may visit our official website at www.psysc.org or our facebook page at www.facebook.com/psysc.inc or call us at (02) 393 4384 or (02) 332 8151. Street No. Street Barangay Town/City Province Region Telephone Number (if any) Fax Number (if any) Area Code Area Code Elementary High School Others _____ Public Private Others _____ Level Type SCIENCE CLUB INFORMATION Registered Name of Science Club SCHOOL INFORMATION Name of School (Do not Abbreviate) Name of Head Adviser Name of Assistant Adviser Mobile Phone Number E-mail address (affiliation materials will be sent here) Total Number of Advisers (including head adviser) : _____ Total Number of Members (including officers) : _____ Last Event Attended : _________ REGISTRATION DETAILS Number of Years to Affiliate: ____ Amount of Money Paid: Php ______ Date of Payment : ______________________ Requirements Checklist Form 1 Form 2 Affiliation Fee QUICK SURVEY Do you have internet access? Do you have LBC Branch on your town/city? How did you learn about PSYSC? PSYSC Brochure PSYSC Website Other Teachers, Name _______________ School of the teacher ________________ Newspaper/Television/Radio Others ____________ Would you like to avail the Science Clubber/ Club Adviser ID? (Php__/pc) Yes How many Science Clubbers? ____ How many Science Advisers? ____ No Certification I hereby declare that the information provided herein are true and correct. Head Adviser Sent Thru Email Event On-Site ____________ Courier Services ___________ Mode of Payment Postal Money Order Event On-Site _________ Landbank of the Philippines Yes No Yes No PHILIPPINE SOCIETY OF YOUTH SCIENCE CLUBS FORM 1

Psysc Form 1

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Page 1: Psysc Form 1

*boxes with check apply those who can join the event

Years Affiliation Fee 11 775500

22 11,,330000

33 11,,990000

44 22,,444400

55 33,,005500

EEVVEENNTTSS AAffffiilliiaatteess NNoonn--

AAffffiilliiaatteess SSaavvee!!

EE ll ee

mmee

nntt aa

rr yy

SS cc hh

oooo

ll

HHii gg

hh SS

cc hhoo

ooll

TT ee a

a cchh

eerr ss

NNaattiioonnaall SScciieennccee CClluubbss

SSuummmmiitt 250 1000 750 ✓

II TTeeaacchh SScciieennccee SSeemmiinnaarr 250 1000 750 ✓

PPSSYYSSCC SScciieennccee OOllyymmppiiaadd

FREE! Exclusive for PSYSC Affiliates

✓ ✓

SSuummmmiitt--MMaatthhSScciiAAKKaa ((EEnnggiinneeeerriinngg SScciieennccee aanndd IInntteerraaccttiivvee WWoorrkksshhooppss))

MMaatthhSScciiAAKKaa ((LLuuzzoonn--bbaasseedd)) ✓ ✓

SSeeaarrcchh ffoorr tthhee MMoosstt OOuuttssttaannddiinngg

SScciieennccee CClluubb ✓ ✓

NNaattiioonnaall CChhiillddrreenn’’ss

SScciieennccee IInntteerraaccttiivvee

WWoorrkksshhoopp 5000 8000 3000 ✓ ✓

NNaattiioonnaall YYoouutthh SScciieennccee

TTeecchhnnoollooggyy aanndd

EEnnvviirroommeenntt SSuummmmeerr CCaammpp

5500 8500 3000 ✓ ✓

FFrreeqquueennttllyy AAsskkeedd QQuueessttiioonnss ((FFAAQQss)) WWhhoo ccaann bbee aaffffiilliiaatteess ooff PPSSYYSSCC?? All science clubs from public and private elementary and high schools.

HHooww mmuucchh iiss tthhee aaffffiilliiaattiioonn ffeeee?? The matrix below shows the affiliation fee corresponding with the number of years of affiliation desired. The longer you affiliate, the more savings you get!

WWhhaatt ddoo wwee ggeett wwhheenn wwee aaffffiilliiaattee?? Assistance to your Local

Science Club Activities

Students’ and Teachers’ Aids

PSYSC Affiliate’s Email Account PSYSC Medal of Excellence for

Science Club Leadership

Science Club ID and Certificates

Exclusive participation in PSYSC Activities and Activity Discounts

HHooww mmaannyy SScciieennccee CClluubbss iinn mmyy

sscchhooooll ccaann aaffffiilliiaattee?? The school can affiliate more than one (1) science club.

HHooww mmaannyy mmeemmbbeerrss ddooeess tthhee

aaffffiilliiaattiioonn ffeeee ccoovveerr?? The affiliation fee is good for an unlimited number of members.

HHooww ddoo wwee aaffffiilliiaattee??

TTHHIISS FFOORRMM IISS FFRREEEE OOFF CCHHAARRGGEE AANNDD MMAAYY BBEE PPHHOOTTOOCCOOPPIIEEDD..

Fill out the PSYSC Information Sheet (Form 1). Print legibly all information required.

Pay the Affiliation fee through either: Landbank of the Philippines Acct. No. 0702-1020-65 and send a photocopy of the deposit slip for PSYSC records

(kindly present the original copy during PSYSC events for verification purposes) or

Postal Money Order payable only to the PHILIPPINE SOCIETY OF YOUTH SCIENCE CLUBS

and send the original postal cheque.

Fill out the Science Club’s Roster of Members and Advisers (Form 2) and send it to [email protected].

Send the requirements for affiliation through: Any courier services (e.g. Postal Mail, LBC, etc.) address to

Unit 703, West Mansions Condominium, Zamboanga Street, Barangay Nayong Kanluran, Quezon City 1104

or

Email by attaching the scanned documents and send to [email protected].

Inform us upon sending the requirements in order for us to track where and when the documents were sent.

Upon Receipt of Payment, Form 1 and Form 2, your science club will be notified by the Affiliations Committee

and the name of your science club will be registered to the PSYSC Database. Your affiliation will start by the time of payment and will end after the number of years you specified to affiliate.

Science Club advisers and members can now enjoy the PSYSC benefits! For more information, you may visit our official website at

www.psysc.org or our facebook page at www.facebook.com/psysc.inc or call us at (02) 393 4384 or (02) 332 8151.

SSttrreeeett NNoo.. SSttrreeeett BBaarraannggaayy

TToowwnn//CCiittyy PPrroovviinnccee RReeggiioonn

TTeelleepphhoonnee NNuummbbeerr ((iiff aannyy)) FFaaxx NNuummbbeerr ((iiff aannyy)) AArreeaa CCooddee AArreeaa CCooddee

EElleemmeennttaarryy HHiigghh SScchhooooll OOtthheerrss __________ PPuubblliicc PPrriivvaattee OOtthheerrss __________

LLeevveell TTyyppee

SSCCIIEENNCCEE CCLLUUBB IINNFFOORRMMAATTIIOONN RReeggiisstteerreedd NNaammee ooff SScciieennccee CClluubb

SSCCHHOOOOLL IINNFFOORRMMAATTIIOONN NNaammee ooff SScchhooooll ((DDoo nnoott AAbbbbrreevviiaattee))

NNaammee ooff HHeeaadd AAddvviisseerr NNaammee ooff AAssssiissttaanntt AAddvviisseerr

MMoobbiillee PPhhoonnee NNuummbbeerr EE--mmaaiill aaddddrreessss ((aaffffiilliiaattiioonn mmaatteerriiaallss wwiillll bbee sseenntt hheerree))

TToottaall NNuummbbeerr ooff AAddvviisseerrss ((iinncclluuddiinngg hheeaadd aaddvviisseerr)) :: __________

TToottaall NNuummbbeerr ooff MMeemmbbeerrss ((iinncclluuddiinngg ooffffiicceerrss)) :: __________

LLaasstt EEvveenntt AAtttteennddeedd :: __________________

RREEGGIISSTTRRAATTIIOONN DDEETTAAIILLSS

NNuummbbeerr ooff YYeeaarrss ttoo AAffffiilliiaattee:: ________ AAmmoouunntt ooff MMoonneeyy PPaaiidd:: PPhhpp ____________

DDaattee ooff PPaayymmeenntt :: ____________________________________________

RReeqquuiirreemmeennttss CChheecckklliisstt FFoorrmm 11 FFoorrmm 22 AAffffiilliiaattiioonn FFeeee

QQUUIICCKK SSUURRVVEEYY

DDoo yyoouu hhaavvee iinntteerrnneett aacccceessss??

DDoo yyoouu hhaavvee LLBBCC BBrraanncchh oonn yyoouurr ttoowwnn//cciittyy??

HHooww ddiidd yyoouu lleeaarrnn aabboouutt PPSSYYSSCC??

PPSSYYSSCC BBrroocchhuurree

PPSSYYSSCC WWeebbssiittee

OOtthheerr TTeeaacchheerrss,, NNaammee ______________________________

SScchhooooll ooff tthhee tteeaacchheerr ________________________________

NNeewwssppaappeerr//TTeelleevviissiioonn//RRaaddiioo

OOtthheerrss ________________________

WWoouulldd yyoouu lliikkee ttoo aavvaaiill tthhee SScciieennccee CClluubbbbeerr// CClluubb AAddvviisseerr IIDD?? ((PPhhpp____//ppcc))

YYeess HHooww mmaannyy SScciieennccee CClluubbbbeerrss?? ________ HHooww mmaannyy SScciieennccee AAddvviisseerrss?? ________

NNoo

Certification I hereby declare that the

information provided herein are true and correct.

Head Adviser

SSeenntt TThhrruu

EEmmaaiill

EEvveenntt OOnn--SSiittee ________________________ CCoouurriieerr SSeerrvviicceess ______________________

MMooddee ooff PPaayymmeenntt

PPoossttaall MMoonneeyy OOrrddeerr

EEvveenntt OOnn--SSiittee __________________ LLaannddbbaannkk ooff tthhee PPhhiilliippppiinneess

YYeess NNoo

YYeess NNoo

PPHHIILLIIPPPPIINNEE SSOOCCIIEETTYY OOFF YYOOUUTTHH SSCCIIEENNCCEE CCLLUUBBSS FFOORRMM 11