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    First National Convention on the Philippine EIS System PC A PI Re g I o n I VA C h Manila Hotel, City of Manila, Philippines 19 to 21 June 2013 ap te REGISTRATION FORM PARTICIPANT INFORMATION (please fill out completely for logistic purposes) Registration Fee Per Participant PhP 7,000.00 PhP 7,500.00 to avail of the early bird rate, payments should be made on or before May 15, 2013.

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    First National Convention on the Philippine EIS System PC A PI Re g I o n I VA C h Manila Hotel, City of Manila, Philippines 19 to 21 June 2013 ap te REGISTRATION FORM PARTICIPANT INFORMATION (please fill out completely for logistic purposes) Registration Fee Per Participant PhP 7,000.00 PhP 7,500.00 to avail of the early bird rate, payments should be made on or before May 15, 2013.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    106 views1 page

    Eia Registration Form

    Uploaded by

    api-211330975
    First National Convention on the Philippine EIS System PC A PI Re g I o n I VA C h Manila Hotel, City of Manila, Philippines 19 to 21 June 2013 ap te REGISTRATION FORM PARTICIPANT INFORMATION (please fill out completely for logistic purposes) Registration Fee Per Participant PhP 7,000.00 PhP 7,500.00 to avail of the early bird rate, payments should be made on or before May 15, 2013.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 1

    First National Convention on the Philippine EIS System

    PC

    A
    PI

    Re
    g i o n I V- A C
    h

    Manila Hotel, City of Manila, Philippines


    19 to 21 June 2013

    ap

    te

    REGISTRATION FORM
    PARTICIPANT INFORMATION (Please fill out completely for logistic purposes)
    NAME :
    ADDRESS:

    Tel. No.

    ______________________________________________________________________________________________
    ______________________________________________________________________________________________
    ______________________________________________________________________________________________
    ______________________ Fax No. _________________________ E-mail: _________________________________

    Sector Represented (please check):




    Gender:
    Male
    Female

    EIA Consultant
    LGU
    Academe

    Private Proponent

    NGA

    Others: ____________

    MMT
    NGO/PO

    Name of Company/MMT: ______________________________________________________________________________________


    Company/MMTs Address: _____________________________________________________________________________________
    Region: _____________________________________________________________________________________________________

    CONVENTION FEE (inclusive of AM/PM snacks and lunch, souvenir program, t-shirt and some give-aways)
    Registration Type
    Not later than 15 May 2013
    16 May to 19 June 2013

    Registration Fee Per Participant


    PhP 7,000.00
    PhP 7,500.00

    To avail of the early bird rate, payments should be made on or before May 15, 2013 (as reflected in their proof of payment, ex: deposit slip).
    Registrations with proofs of payment will be considered confirmed by the Secretariat through an email.
    An Official Receipt shall be given to the participant during on-site registration.

    T-SHIRT SIZE
    To get a correct t-shirt size, please encircle applicable size below:
    Size
    XS
    S
    M
    1/2
    1/2
    Width at breast (inches)
    18
    19
    20 1/2
    Length (inches)
    25
    26
    27

    L
    21 1/2
    28

    XL
    22 1/2
    30

    2XL
    24
    31

    By registering early, participants will have the opportunity to indicate their preferred t-shirt size.

    MODE OF PAYMENT
    Cash
    Cheque: Payment will be done during the Convention

    Please prepare check payable to PCAPI-REGION IV-A CHAPTER, INC.
    Deposit through Bank:
    Account Name
    Account No
    Name of Bank
    Branch

    :
    :
    :
    :

    PCAPI-REGION IV-A CHAPTER, INC.


    0911-0147-42 (Current)
    Bank of the Philippine Islands (BPI)
    Los Baos

    TO RECEIVE A CONFIRMATION OF YOUR REGISTRATION PLEASE FAX FILLED UP REGISTRATION FORM AND DEPOSIT SLIP
    TO +63 (49) 5011706 or TO EMAIL ADDRESSES: eia.pcapir4a@yahoo.com.ph / hlpatindol@yahoo.com

    CONTACT INFORMATION
    Ms. Hannah Patindol

    M: 0917-8144751

    T: +63 (49) 501-1706

    ( for Secretariat use )

    Date of Registration:

    Registration Control No.:


    www.phileiaconvention.org

    E: eia.pcapir4a@yahoo.com.ph
    hlpatindol@yahoo.com

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