66th national midyear registration form (1).pdf
TRANSCRIPT
--- Registration will only be processed if all requested information is provided and accompanied by full payment. ---
LAST NAME FIRST NAME EXT MIDDLE NAME NAME TO APPEAR ON ID
R E G I S T R A T I O N F O R M
Name
IECEP ID Number IECEP Chapter Affiliation
PRC License Number
PECE ECE ECT
PRC Expiration Date
E-mail Address Mobile Number
Company
Type of Industry
Academe Consultancy Management Power Sector
Broadcasting Electronics Manufacturing Semiconductor
Computer Government Military Telecommunication
Construction Information Technology Others: _______________________________________
__________________________________________
Signature
--- Please accomplish the form and submit via email to: [email protected] ---
FOR IECEP MIDYEAR CONVENTION SECRETARIAT USE ONLY
Conference Registration Number
Payment Mode Cash Check Bank
Payment Type Pre-registered On-site Non-paying
Payment Date Amount Paid
Check Number (for company check payments)
IECEP O.R. Number Issued Date Issued
Payment can be deposited to:Account Name: Institute of Electronics Engineers of the Philippines, Inc-SOCCSKSARGENAccount Number: 009343-0373-22 Bank Name: BPI-GenSan Santiago Branch