DATA PRIVACY CONSENT AGREEMENT
Act No. 10173 (Act), also known as the Data Privacy Act of 2012, with respect to the data they
collect, record, organize, update, use, consolidate or destruct from our members.
The personal data obtained from this Membership Form is entered and stored by the Regional Vice
President for Membership within secured drive and will only be accessed by the authorized
physical security measures to ensure the protection of the members’ personal data.
Furthermore, the information collected and stored from our members shall only be used for the
following purposes:
1. Processing and reporting of documents related to the membership, (e.g., Membership Report).
2. Activities pertaining to establishing relations with sponsors and alumni.
t disclose the member’s personal information without their consent and shall retain this information
over a period of ten years for the effective implementation and management of the organization.
MEMBER CONSENT
I have read the Data Privacy Statement of collect, record, organize, update or modify, retrieve,
consult, use, consolidate, block, erase or destruct my personal data as part of my information.
I hereby affirm my right to be informed, object to processing, access and rectify, suspend or
withdraw my personal data, and be indemnified in case of damages pursuant to the provisions of the
Republic Act No. 10173 of the Philippines, Data Privacy Act of 2012 and its corresponding
Implementing Rules and Regulations.
_____________________________ _________________
Signature over printed name Date