PHILIPPINE LEAGUE OF SECRETARIES TO THE SANGGUNIAN, INC.

(PLEASES, INC.)
OFFICE OF THE NATIONAL PRESIDENT
Coordinating Office: Municipal Hall, Veruela, Agusan del Sur
Mobile No. 09396209871; E-mail address: bardon6_24_2006@yahoo.com

RE-PAID REGISTRATION FORM

TO : THE CONFERENCE DIRECTOR/PRE-REGISTRATION IN-CHARGE

Secretary Paulo Tagsip & Team

FROM : _____________________________ DATE: _____________

________________________ _________________ __________

City/Municipality Province Region

Contact person: ___________________ Phone No. ____________

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SUMMARY LIST OF REGISTERED PARTICIPANTS
(use additional sheet if necessary)

NAME/S Gender POSITION BANK, BRANCH & AMOUNT

(M/F) DATE DEPOSITED
1.
2.
3.
4.
5.
6.
7.
8.
9.

Note: Please email this form mrd_solcherries96@yahoo.com copy furnished at

bardon6_24_2006@yahoo.com together with the filled-out Registration Form and photocopy
of your deposit slip.

Kindly bring these forms with the original copy of the deposit slip and present to the Pre-
registration table.

Cash and check deposits can be made to: PLEASES INC. with Current Account No. 0752-
1103-79, Land Bank of the Philippines, Koronadal Branch.

1
 PHILIPPINE LEAGUE OF SECRETARIES TO THE SANGGUNIAN, INC.
(PLEASES, INC.)
OFFICE OF THE NATIONAL PRESIDENT
Coordinating Office: Municipal Hall, Veruela, Agusan del Sur
Mobile No. 09396209871; E-mail address: bardon6_24_2006@yahoo.com

Seminar-Workshop on Scaling up Devolved Services and its Implications to

Socio—Economic Program Sustainability cum 2nd National Executive and
Board of Trustees Conferences

REGISTRATION FORM
(to be filled out by each delegate)

Name: ______________________________________________ Nickname: _______________

First MI Surname

Position: _________________________________________ Sex: _____ Marital Status ______

Tele/Fax No. _____________________ Mobile No.(s) _________________________________

LGU/Station: _____________________________________ Email:________________________

City/Municipality Province Region

Date and Time of: Arrival:_______________________ Return Trip: _____________________

Signature: _____________________

Note:

Please legibly fill out the data needed and together with other docs, email the same to
pauldagami629@yahoo.com.

2
 PHILIPPINE LEAGUE OF SECRETARIES TO THE SANGGUNIAN, INC.
(PLEASES, INC.)
OFFICE OF THE NATIONAL PRESIDENT
Coordinating Office: Municipal Hall, Veruela, Agusan del Sur
Mobile No. 09396209871; E-mail address: bardon6_24_2006@yahoo.com

SEC Reg. No. AN096-00987 TIN 004-412-708-000 DILG-1996 Accredited National League
ULAP-1999 Registered League as Associate Member

KALINGA SA KALIHIM MEMBER’S DATA SHEET

(To be filled out by PLEASES member only)

NAME OF MEMBER: _______________________ __________________ ___________________

Family Name Given Name Middle Name

1.0 CONTACT DETAILS: _______________ / __________ / _________ / ___________________

Mobile No. Office Tel. No. Fax No. Email Address
2.0 RESIDENTIAL ADDRESS:
___________________________________________________________
3.0 OFFICE
ADDRESS:________________________________________________________
___________
4.0 LOCAL GOVERNMENT UNIT: _____________________/ _________________
/________________
Municipality / City / Province Region
5.0 APPOINTMENT/DESIGNATION: ___________________ / __________
/______________________
Position Status Date of Appointment

6.0 BIRTH DATE AND PLACE: ___________________________________________________

7.0 MARITAL STATUS: Single Married Widow(er) Legally Separate
________________ / ____________ /__________ / ____________
Name of Spouse _______________________________________
Address ___________________________________Contact Number ___________No. of Children
_____

8. EDUCATIONAL ATTAINMENT: _____________________ /_______

/_________________________
College Degree Obtained Year Graduated Name of College/University
_______________________ /________________ / _________________________________________
Post Graduate Studies Year Graduated Name of College/University

9. PERSON TO CONTACT IN CASE OF EMERGENCY______________________ /

__________________
Name Relationship
10. CONTACT DETAILS: _______________ /__________________/
____________________________
Mobile No Email Address Bank name/Acct. No.

Residential Address ________________________________________

11. BENEFICIARY:____________________________ /______________/_______________________

Name Relationship Bank Name & Account No.
12. CONTACT DETAILS:___________________ / ______________ / __________ / ______________
Tel. No. Mobile No. Email Address

Residential Address:_____________________________________________________

3
 PHILIPPINE LEAGUE OF SECRETARIES TO THE SANGGUNIAN, INC.
(PLEASES, INC.)
OFFICE OF THE NATIONAL PRESIDENT
Coordinating Office: Municipal Hall, Veruela, Agusan del Sur
Mobile No. 09396209871; E-mail address: bardon6_24_2006@yahoo.com

__________________________________ __________________________
Signature over Printed Name Date Accomplished
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Membership Classification: ___Charter Member ____ Regular Member ___ Lifetime Member
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