Confirmation Slip for Public Delegates of SocDev2016 and CODE-NGO 25th Anniversary
November 23-24, 2016 - Sequoia Hotel, 91-93 Mother Ignacia Avenue corner Timog Avenue, Quezon City, Philippines
Theme: “CODE-NGO @25: Networking, Empowering and Transforming for Social Justice and Sustainable Development”
PERSONAL INFORMATION
1. Last name
Your answer
2. First name
Your answer
3. Middle initial
Your answer
4. Nickname
Your answer
5. Birthdate
MM
/
DD
/
YYYY
6. Organization
Your answer
7. Designation
Your answer
8. Address
Your answer
9. Telephone number
Your answer
10. Mobile number
Your answer
11. Email
Your answer
SECTOR
12. I come from the following sector:
SESSIONS
13. I will attend the following sessions:
Required
I will deposit the registration fee of PhP900 which is required from each delegate (in addition to the payment for meals above, if applicable) to the CODE-NGO bank account details below:
Account name: Caucus of Development NGO Networks
Bank name: Bank of the Philippine Islands
Branch: Loyola-Katipunan
Account number: 3081-0753-43

Afterwhich, I will email (sdw@code-ngo.org) or fax (+632 9202595 loc.101) my deposit slip to CODE-NGO by November 9, 2016.

FOOD/DIETARY REQUIREMENTS/PREFERENCES
14. My food/dietary requirements/preferences are as follows:
For inquiries, please call the CODE-NGO Secretariat at (02) 920.2595 or 435.6616 or text Mikee 0935.6862294, Dimple – 0939.1255204 or Cel – 0917.7342259.
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