PHILIPPINE INSTITUTE OF CERTIFIED PUBLIC ACCOUNTANTS

74th Annual National Convention

November 20-23, 2019
Centenial Convention Center, Laoag City, Ilocos Norte
PICPA

REGISTRATION FORM
INFORMATION
FIRST NAME MIDDLE NAME LAST NAME NICKNAME SEX

CPA NO. SECTOR (PLEASE CHECK) RELIGION CHAPTER

COMMERCE & INDUSTRY GOVERNMENT
EDUCATION PUBLIC PRACTICE
ADDRESS CONTACT NO EMAIL ADDRESS

BUSINESS / COMPANY / INSTITUTION AFFILIATED WITH TITLE / POSITION DIET RESTRICTION T-SHIRT SIZE (please check)
XS M XL 3XL
S L XXL

REGISTRATION FEE REMITTANCE

INCLUSIVE OF 12% VAT Registration shall be valid upon receipt of completed Registration Form &
proof of payment.
ON / OR BEFORE September 15, 2019 CASH ₱
Individual ₱ 8,000.00
Group of 10 persons (per person) ₱ 7,500.00

CHECK ₱
SEPTEMBER 15 TO OCTOBER 15, 2019
Individual or Group ₱ 8,500.00
Bank Name & Branch
AFTER OCTOBER 15 AND ON-SITE * Check No.
Individual or Group ₱ 10,000.00 Date of Check
*subject to the availability of slots. DEPOSIT TO:
*on-site registration is not encouraged PAYEE: 74th PICPA ANC PAYEE: 74th PICPA ANNUAL
NOTE Maybank Philippines NATIONAL CONVENTION
1. Venue can only accommodate 5,000 participants. On-site Laoag City Branch Banco de Oro (BDO)
registration will only be allowed if slots are available Account No: 0036 5000 886 Laog-Castro Branch
Account No: 0009 6801 5752
2. Cancellation or Refund will only be entertained until October 31, PAYEE: 74th PICPA ANNUAL NATIONAL CONVENTION
2019, with an administrative fee of 20% of paid registration fee. Development Bank of the Philippines- Laoag Branch
Account No: 00-0-01419-545-0
3. Please ensure that this form is clearly and completely filled up.
You can also pay on our website www.74th.picpaanc.com through PAYPAL
Potential CPD Credits: 24 Units, subject to the approval of the Professional Regulatory Commission (PRC)

Email or send the completed form and proof of payment (i.e. deposit slip) to:

CONVENTION SECRETARIAT: Tel Nos: 09175707503 / (077) 600-3244

09778541025 / 09338142644
PICPA ILOCOS NORTE-LAOAG CITY CHAPTER Email Address: administrator@picpaanc.com
Office of the City Accountant
City Hall, Brgy 10 San Jose, Facebook Page: 74th PICPA Annual National Convention
Laoag City, Ilocos Norte
Website: https://74th.picpaanc.com

For Convention Secretariat use only:

CONTROL NO.: DATE RECEIVED: BY: STATUS