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LEAP Conference Reg Form

The document is a registration form for the LEAP 2012 conference, requesting attendees to provide their contact information and details on payment. It instructs participants to fax or email the completed form along with proof of payment to secure their spots at the event. Additional guidance is provided for students, educators, and groups registering together.

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Joyce
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© Attribution Non-Commercial (BY-NC)
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Download as DOC, PDF, TXT or read online on Scribd
38 views

LEAP Conference Reg Form

The document is a registration form for the LEAP 2012 conference, requesting attendees to provide their contact information and details on payment. It instructs participants to fax or email the completed form along with proof of payment to secure their spots at the event. Additional guidance is provided for students, educators, and groups registering together.

Uploaded by

Joyce
Copyright
© Attribution Non-Commercial (BY-NC)
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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LEAP 2012 Registration Form for Individuals

Please fill out this registration form and fax it to (+632)9206923/ 9279238 along with a copy of your deposit slip to ensure your slots. You may also scan the deposit slip and email it together with this form to [email protected] IMPORTANT: Please do not forget to bring your deposit slips during the conference proper to get your official receipts. Thank you! Name: School/Company/Organization: Company/ School/ Org Address: School Org Tel. Nos. / Mobile Nos. : Home Address: Home Tel. Nos. / Mobile Nos. : School/ Org Fax: Home Fax: Designation: Email:

Are you registering for a group? If so, kindly fill out the group registration form (page 2) and fax it to the number provided together with the deposit slip. Additional reminders: For students and educators For participants from LGUs/NGOs/NGAs Payment Details BPI Account Name: BPI Acct Number: Or Phil Veterans Bank Acct Name: SERDEF Phil Veterans Bank Acct Number: 0037000462001 SERDEF 003081066328 Include a photocopy of your valid school IDs Include a photocopy of your valid organizational IDs

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LEAP 2012 Group Registration Form


Please fill out this registration form and fax it to (+632)9206923/ 9279238 along with a copy of your deposit slip to ensure your slots. You may also scan the deposit slip and email it together with this form to [email protected] IMPORTANT: Please do not forget to bring your deposit slips during the conference proper to get your official receipts. Thank you! Additional reminders: For students and educators For participants from LGUs/NGOs/NGAs Payment Details BPI Account Name: BPI Acct Number: Or Phil Veterans Bank Acct Name: SERDEF Phil Veterans Bank Acct Number: 0037000462001 Groups of more than 5 participants may use a separate sheet for registration.
1 Name: School/Company/Organization: Company/ School/ Org Address: School Org Tel. Nos. / Mobile Nos. : Home Address: Home Tel. Nos. / Mobile Nos. : 2 Name: School/Company/Organization: Company/ School/ Org Address: School Org Tel. Nos. / Mobile Nos. : Home Address: Home Tel. Nos. / Mobile Nos. : 3 Name: School/Company/Organization: Company/ School/ Org Address: School Org Tel. Nos. / Mobile Nos. : Home Address: Home Tel. Nos. / Mobile Nos. : 4 Name: School/Company/Organization: Company/ School/ Org Address: School Org Tel. Nos. / Mobile Nos. : Home Address: Home Tel. Nos. / Mobile Nos. : School/ Org Fax: Home Fax: Designation: Email: School/ Org Fax: Home Fax: Designation: Email: School/ Org Fax: Home Fax: Designation: Email: School/ Org Fax: Home Fax: Designation: Email: Designation: Email:

Include a photocopy of your valid school IDs Include a photocopy of your valid organizational IDs

SERDEF 003081066328

5
Name: School/Company/Organization: Company/ School/ Org Address: School Org Tel. Nos. / Mobile Nos. : Home Address: Home Tel. Nos. / Mobile Nos. : School/ Org Fax: Home Fax:

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