B.RE.A.T.HE: A Conference on the Business, Regulatory, Accounting, and Tax Concerns of the Healthcare Industry
February 18, 2019, 8:00 AM-5:00 PM
Cervantes and Shakespeare Hall, Discovery Primea
6749 Ayala Avenue
Makati City

Contact us at (632) 982-9179 or anaroxas@reyestacandong.com

Email address *
I. PERSONAL DETAILS
A. Last Name *
B. First Name *
C. Middle Name *
D. Position *
E. Email Address *
F. Mobile Number *
G. Telephone Number *
H. PRC ID Number (input N/A if none) *
II. COMPANY DETAILS
A. Company Name *
B. Company Address *
C. Company TIN *
D. Company Contact Number *
III. PAYMENT DETAILS
A. Session to Attend *
B. Mode of Payment *
B.1. Deposit Slip (for BANK DEPOSIT)
B.1.1. Please attach a copy of your deposit slip here.
B.2. Pick Up Details (for PICK UP OPTION)
Please provide for the following details:
B.2.1. DATE of Pick Up
MM
/
DD
/
YYYY
B.2.2. TIME of Pick Up
Time
:
B.2.3. Name of Person Releasing the Payment (POINT PERSON)
B.2.4. MOBILE NUMBER of Point Person
B.2.5. ADDRESS of Pick Up
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