DigitalFilipino E-Commerce Summit 2012 Delegate Registration Form

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YES! I / We would like to attend the DigitalFilipino E-Commerce Summit 2012.

Free conference pass to DigitalFilipino Club members (http://www.e-commercephilippines.com):

- individual members (participate as themselves, no proxy)
- SME members (2 representatives)
- Corporate members (3 representatives)
- DigitalFilipino Web Awards 2011 winner (1 slot)

- Non-members can pay based on the following schedule:
at P5,000 if payment is received on or before January 31, 2012
at P6,000 if payment is received on or before February 23, 2012
at P7,000 (if paid after the event)

Club members wanting extra slot can pay based on the above fees but with 15% discount.

Name *

Address *

Position *

Telephone *

Company *

Fax *

Website

Payment Options *

Choose your preferred payment method.

Comments *

Please indicate names of delegates and any special instruction for billing purposes. For individual members, cite which day you'll be attending.

DigitalFilipino.com Club Member *

Please indicate if you are a club member.

Yes

E-mail address *

Receive confirmation of your registration.

Submit

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