MEETINGS :: Mindanao Conference 2012 :: Registration
Please take note...
Write only one (1) e-mail address in case you have two or more. Multiple addresses in this box will prevent your application from reaching us. Write your other address/es in the next box.
Membership Number (For active and inactive members only.)
Nickname to Appear in the Conference ID
Date of Birth (Date, Month & Year)
Postal Address (Complete address where you can receive mail by post or courier.)
Other E-mail Address/es
Landline/s (Include area code.)
27 November 1994
22 Beltran St., Central, San Marcelino, Zambales 2211
046 876 5432
0917 834 0424, 0918 834 0424
Amount / Transaction Code
The transaction code is the entire third line of the machine validation printout on your bank deposit slip stub starting with the date in <mm-dd-yy> format and time in <hh:mm:ss> format followed by four alpha-numeric codes.
PHP1,500.00 / 01-20-12 15:45:03 021N 48 2795 614