REGISTRATION FORM

Please accomplish the form and send thru fax at 920-7418/920-7412/928-6095 or email to
ncm.registrar@dict.gov.ph or on or before 25 November 2016.

I will attend I will not attend

Event : 2016 Year-End Assessment and 2017 Capability Development Program Launch
Date : December 6, 2016
Time : 8:00 A.M. to 5:00 P.M.

Please complete all fields.

Agency/Company Details
Agency
Address

Tel. #
Fax #

Your Details
Surname
First Name
Middle Name
Designation
Email Address
Contact Nos.

DICT Building, C.P. Garcia Avenue,

Diliman, Quezon City 1101 Trunkline (+632) 920-0101