26 – 28 November 2018 | Marco Polo Davao

REGISTRATION FORM

LGU

Municipality/City: ______________________________________________________________

Province: ____________________________________________________________________

Attendees’ Names
Participant 1:

First name: _____________________________Last Name: ____________________________

Nickname (This name shall appear in your conferencebadge):________________________________________

Position/Designation/Department:_________________________________________________

Address:_____________________________________________________________________

Phone number: ________________________ Mobile Number: __________________________

Email address:________________________________________________________________

___________________________ _______________
Attendee’s Signature over Printed Name Date Signed

Participant 2:

First name: _____________________________Last Name: ____________________________

Nickname (This name shall appear in your conferencebadge):________________________________________

Position/Designation/Department:_________________________________________________

Address:_____________________________________________________________________

Phone number: ________________________ Mobile Number: __________________________

Email address:________________________________________________________________

___________________________ _______________
Attendee’s Signature over Printed Name Date Signed
Participant 3:

First name: _____________________________Last Name: ____________________________

Nickname (This name shall appear in your conferencebadge):________________________________________

Position/Designation/Department:_________________________________________________

Address:_____________________________________________________________________

Phone number: ________________________ Mobile Number: __________________________

Email address:________________________________________________________________

___________________________ _______________
Attendee’s Signature over Printed Name Date Signed

Please deposit payments to NABPLO Philippines Inc.

Bank:
Account name: NABPLO Philippines Inc.
Account number:

For slot confirmation, please e-mail the registration form together with the scanned deposit slip to
nabplophilippines@gmail.com. Receipts could be mailed to a specified address or could be claimed on the day of
the convention.