DELEGATES’ PRE-REGISTRATION FORM Water Challenge Forum 2013 One-Day Forum & Exhibition 8 November 2013, Friday 8:00AM to 6:00PM Marriott Manila (Please fax completed form to 8451323) Company Name:__________________________________________________________ Complete Address:________________________________________________________ Company TIN: ____________________________________________________________ Contact Person:___________________________________________________________ Telephone no:___________________________ Fax no: __________________________ E-mail:________________________________________ This is to confirm attendance of the following participants: I. ATTENDEES: Name
Designation
Email Address
II. REGISTRATION FEE (Please tick) ECCP Members/Exhibitors/Sponsors/Government / Academe/Students (w/ID) Non-Members
3,500Php 3,800Php
The registration fee includes participation in all plenary sessions, morning & afternoon snacks, lunch and conference kit. III. PAYMENT: (Please choose your preferred payment option) Check for pick-up Direct Payment to ECCP office Date & Time of pick-up:__________________ Send to: ECCP Office, 19/F Philippine AXA Life Contact Person:________________________ Center, Gil Puyat Ave. Makati. Look for: Vicky Regoniel Check for Deposit (Please fax the deposit slip to 759-6690 and call Vicky Regoniel at 845-1324 to notify us that payment has been made) ECCP Account Details: Account Name: ECCP Account #: 000-009621-040 Bank: HSBC, Ayala Avenue
NOTE: Pre-Registration is REQUIRED. Cancellation or Request for refund will be accepted if notification is given in writing at least 3 working days prior the event, otherwise, full participation fees will be charged.