LEAP 2012 Registration Form
Please fill out this registration form and fax it to (+632)9206923/ 9279238 along with a copy of your
deposit slip to ensure your slots. You may also scan the deposit slip and email it together with this form
to leapcon2012@gmail.com
Name:
School/Company/Organization:
Tel. Nos. / Mobile Nos. :
Designation:
Email:
Fax:
Are you registering for a group? If so, kindly fill out the group registration form below and fax it the
number provided together with the deposit slip. (For students: include a photocopy of your valid school
IDs)
Payment Details
BPI or VETERANS BANK Account Name:
Small Enterprises Research and Development Foundation (SERDEF)
BPI Acct Number: 003081066328 Phil Veterans Bank Acct Number: 0037000462001
Group Registration Form:
IMPORTANT:
Please do not forget to bring your deposit slips during the conference proper to get your official
receipts. Thank you!
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Designation:
School/Company/Organization:
Email:
Tel. Nos. / Mobile Nos. :
Fax:
Name:
Designation:
School/Company/Organization:
Email:
Tel. Nos. / Mobile Nos. :
Fax:
Name:
Designation:
School/Company/Organization:
Email:
Tel. Nos. / Mobile Nos. :
Fax:
Name:
Designation:
School/Company/Organization:
Email:
Tel. Nos. / Mobile Nos. :
Fax:
Name:
Designation:
School/Company/Organization:
Email:
Tel. Nos. / Mobile Nos. :
Fax:
Name:
Designation:
School/Company/Organization:
Email:
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Name:
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Groups of more than 8 participants may use a separate sheet for registration.
Name:
Designation:
School/Company/Organization:
Email:
Tel. Nos. / Mobile Nos. :
Fax:
Name:
Designation:
School/Company/Organization:
Email:
Tel. Nos. / Mobile Nos. :
Fax:
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Fax:
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Tel. Nos. / Mobile Nos. :