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PROMOTING

Integrity.
ADVANCING
Excellence.
PHILIPPINE INSTITUTE OF CERTIFIED PUBLIC ACCOUNTANTS

2nd Caraga CPA Conference


Bislig City Cultural and Sports Complex
Bislig City, Surigao Del Sur
February 27 - March 1, 2019

REGISTRATION FORM
INFORMATION
LAST NAME FIRST NAME MIDDLE NAME NICKNAME SEX

CPA NO. SECTOR (please check)


REGION CHAPTER
COMMERCE & INDUSTRY GOVERNMENT

EDUCATION PUBLIC PRACTICE

ADDRESS CONTACT NO. EMAIL ADD.

BUSINESS/COMPANY/INSTITUTION AFFILIATED WITH TITLE / POSITION

REGISTRATION FEE REMITTANCE

INCLUSIVE OF 12% VAT Registration shall be valid upon receipt of completed


Registration Form & proof of payment.

ON OF BEFORE JANUARY 15, 2019


Cash ₱
Individual ₱ 5,000.00

AFTER JANUARY 15, 2019


Check ₱
Individual ₱ 5,500.00 Bank Name & Branch

Check No.
* subject to the availability of slots.
Date of Check

NOTE
PAYEE:
1. Venue can only accommodate 500 participants. On-site
registration will only be allowed if slots are available. PICPA SURIGAO DEL SUR CHAPTER
2. Cancellation or Refund will only be entertained until Feb.15, 2019, Deposit To:
with an administrative fee of 20% of paid registration fee. Philippine National Bank - Bislig City Branch
3. Please ensure that this form is clearly and completely filled up. Current Account no.: 4004-1001-4727

Potential CPD Credits: 24 Units, subject to the approval of the Professional Regulation Commission (PRC)
Email or send the completed form and proof of payment (i.e. deposit slip) to: Tel. Nos. 0916-591-4328 - Tess Taripe
0998-966-2815 - Melody Patiño
CONVENTION SECRETARIAT:
0920-958-2166 - Raquel Bautista
PICPA Bislig Chapter 0946-851-9944 - Irine Georfo
Bislig City

For Convention Secretariat use only:

CONTROL NO._______________ DATE RECEIVED: ________________ BY:___________________ STATUS: _________________