INTEGRATED BAR OF THE PHILIPPINES

REGISTRATION FORM March 27-31, 2019

Name: ..........................................................................................................

Chapter: .......................................................................................................

Roll of Attorney No: ......................... IBP Lifetime No. .........................

Office Address: ............................................................................................

Office Telephone No: ................................................................................ Fax No.: .............................................................

E-mail Address: .......................................................................................... Mobile No.: ........................................................

Home Address: ........................................................................................... Tel. No.: ..............................................................

Registration Fee: ....................................................................... Date Paid: .............................................................................

REGISTRATION FEES:
Early Bird (from November 1 to December 31, 2018) P 9,000.00 On-Site (March 27, 2019 onwards) P 10,000.00
Regular (from January 1 to March 26, 2019) P 9,500.00

REGISTRATION FEES: Payment can be made by any of these options:

Check If paying by Check, please make the check payable to INTEGRATED BAR OF THE PHILIPPINES
Cash For Deposit Payments:
Bank Deposit BDO Bank Account Name : INTEGRATED BAR OF THE PHILIPPINES
Online Account Number : 002110002022
Reference Number : 00RNNCL (00+Roll Number+NCL) example: 0012345NCL
(Kindly transmit a copy of the validated deposit slip and accomplished regis-
tration form to the Convention Secretariat via telefacsimile or by e-mail)

For Online registration and payment, download and install IBP App, available by November 2018

By signing this form, you agree that the Integrated Bar of the Philippines ( “IBP” or the “organization”) may collect, use and
disclose your personal data, as provided herein, for the following purposes: (1) registration and processing of attendance of
the 2018 National Convention of Lawyers; (2) the updating and maintenance of your membership with the IBP; and (3) other
lawful and legitimate interests within the authority of the IBP as may be mandated by pertinent law. Further note that informa-
tion that involve matters of public interest may be disclosed to the public. Rest assured that security controls are implemented
to protect all the information provided for in this document.

Signature over Printed Name Date

INTEGRATED BAR OF THE PHILIPPINES

IBP Building, 15 Doña Julia Vargas Avenue, Ortigas Center, Pasig City
Tel. Nos.: (632) 634-4696 / Telefax: (632) 631-1158; (632) 910-0406
Mobile Nos.: 09062672100 / 09205651836 / 99458398613
Email Add.: 17thncl@gmail.com