CCNAPI ANNUAL CONVENTION 2014

DARE TO SHINE Venue: Diamond Hotel Philippines February 18 and 19, 2014

CCNAPI SECRETARIAT USE ONLY:

Date of Registration: ____________________ O.R. Number: __________________________ Received by: __________________________

R E G I S T R A T I O N F O R M

PERSONAL INFORMATION
MR LAST NAME: ADDRESS: TEL. NO: CCNAPI MEMBERSHIP NO: PRC. NO: CURRENT INSTITUTION / AFFILIATION(S): VALID UNTIL: MOBILE NO: EMAIL ADD: VALID UNTIL: PROF. MEMBERSHIP: MS. MRS RN BSN MAN PhD others: ______ MIDDLE INITIAL:

FIRST NAME:

DEPARTMENT: WORK ADDRESS:

POSITION:

MODE OF PAYMENT
INDIVIDUAL REGISTRATION Pre-Registration Member Onsite Registration Member GROUP REGISTRATION Pre-registration (Group)
________ CASH ________ CHECK

Php 3,500.00 Php 4,000.00 Php 35,000.00

Non-Member Non-Member

Php 4,000.00 Php4,500.00 Php 38,000.00

Onsite Registration (Group)

________ BANK TRANSFER (kindly send deposit slip) Bank ______________________________________ Check Number _____________________________

CANCELLATION AND REFUND:

Total amount of Refund will not be given to those who will be cancelling their registration. Considerations may be given to the following: o For cancellation made One (1) month prior to the convention, Twenty Five Percent (25%) of the total registration fee shall be deducted. o For cancellation made Two (2) weeks prior to the convention, Fifty Percent (50%) of the total registration fee shall be deducted. o For cancellation made One (1) week prior to the convention, Seventy Five Percent (75%) of the total registration fee shall be deducted. o No Refund shall be given on the day of the convention.

TRANSFER OF REGISTRATION:
In the event that you are unable to attend the convention, your registration is transferable at no additional charge. Contact the Secretariat if you wish to transfer your registration to another person. Please fill up another registration form for the person you wish to transfer your registration and attach your registration form and payment receipt. Transfer request should be made at least ONE WEEK prior to the convention.

REGISTRATION COVERAGE:
Admission to all Convention Program (Plenary sessions and Selected Workshop / Conference Kit / Admission to opening ceremonies / Entrance to booth exhibits / One (1) Certificate of Participation / AM, PM Snacks and Lunch for 2 days

DATE:

SIGNATURE: