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Bulacan State University

In collaboration with

Korea Convergence Society

INTERNATIONAL RESEARCH CONFERENCE ON INNVATION, TECHNOLOGY AND SUSTAINABILITY

Theme: “Engaging People through Relevant and Socially-Responsive Research,

Innovation and Technology Towards Sustainability.”

January 9-11, 2018, The Widus Hotel & Casino, Clark, Angeles City, Pampanga

REGISTRATION/CONFIRMATION SLIP

Complete Name: _____________________________________ Nickname: _____________________

Position/Designation:

____________________________________________________________________

Agency: ________________________________________________________________________________

Phone: _____________________________________ Fax: ______________________________________

Email:

______________________________________ Mobile: ___________________________________

Region: ____________________________________ Food Restriction:

__________________________

Will join tour : Yes _______ No _______ Health Condition:

_________________________

_______________________________________________________________________

MODE OF PAYMENT:

________ Early registration (to confirm slot) Payment may be deposited to:

For International Participants:

Account Name: BULACAN STATE UNIVERSITY

Bank: LAND BANK OF THE PHILIPPINES

Branch: MALOLOS HIGHWAY

Account Number: 2794-0032-22

Swift code: TLBPPHMMXXX

For Local Participants:

Account Name: BULACAN STATE UNIVERSITY

Bank: LAND BANK OF THE PHILIPPINES

Branch: MALOLOS HIGHWAY

Account Number: 2792-1005-22

After depositing your payment, kindly send a scanned copy of the deposit slip to __________________________. Kindly indicate name of attendees and agency/school/organization for the issuance of the official receipt.

________ Payment will be made upon registration on January 8, 2018.

_______________________________ __________________________________

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Name & Signature of the Applicant Name & Signature of Agency Head

Kindly accomplish the slip and submit it to us on or before OCTOBER 30, 2018. Email: __________________________ Thank you very much!

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Referensi

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