REGISTRATIONFORM

Name of Institution: Is your institution a member of MCPI? Tel No.: Email: Name Scholar (if MCPI Member): Nickname Check-in Date Check-out Date ( ) Yes Fax No.: ( ) No

Participants:

Nickname

Form accomplished by:

(Signature over printed name)

Regularconferencefeefornonscholarsis: PHP3,000forMCPImembers PHP5,000fornonMCPImembers Pleasedeposityourpaymentsto: BankofthePhilippineIslands AccountName:MicrofinanceCouncilofthePhilippines,Inc. AccountNo.:2431060453

CONFIRMATIONOFPAYMENT
We hereby confirm the deposit of our payment for the above-named conference at the __________________ branch of the Bank of the Philippine Islands. Amount deposited is _____________________(PHP__________). *** Please send a copy of the validated deposit slip from the Bank of the Philippine Islands (photocopy whole page) and accomplished registration form to MCPI at fax no. (02) 631-5920. Deadline for submission of registration forms and payments is on July 13, 2012.