21st Governance Boot Camp: Basic Class Registration Form

21st Governance Boot Camp: Basic Class

February 18 to 21, 2020 (with Day 0 accommodation) | Courtyard by Marriott, Iloilo City
Please note that we have a cap of 5 delegates per organization for this workshop.

Should you wish to send more participants, please contact Ms. Glydelle Amon (gamon@isacenter.org). Thank you!
Full name (name to appear on your certificate)*
Please don't forget to include your post-nominals. (e.g. Dr. Juan Dela Cruz, MMHoA)
Organization*
Department and designation*
Email address*
Mobile number*
Phone number*
What name would you like to appear on your ID?*
Please indicate your nickname and last name.
Dietary restriction/s*
Would you like for us to send the Boot Camp materials to another point person? If yes, please indicate their name and email address.
Participation fee (inclusive of 4D3N room accommodation from Feb 18 - 21 (Tues-Fri)*

BASIC CLASS Regular (PHP 36,000 per pax)BASIC CLASS Group of 5 (PHP 34,000 per pax)
Mode of payment*

CashChequeBank Deposit
Bank Details

Institute for Solidarity in Asia, Inc.

Land Bank of the Philippines

Buendia Branch

0052-1410-52

BDO

Trident - Gil Puyat

006-838-037-511

BPI

Buendia South Superhighway

1141-0109-28
Who can we coordinate with from your office regarding payments? Please indicate their name, designation, email, and contact number.*
NOTE: The personal information submitted herein shall be used for the 21st Governance Boot Camp - Basic Class online registration. Data will be shared to co-delegates and photos taken during the workshop will be published in our social media channels and website.

All the information submitted herein shall be used for the purpose stated above, the other legitimate interests of the Institute for Solidarity in Asia (ISA), and any other processing as may be required by law. Security measures are in place to protect all information in this document.

Terms and Conditions
1. All fees are inclusive of taxes.
2. Registration will be open until Friday, February 7, 2020.
3. Please note that we have limited slots. You slot will be reserved upon submission of the registration forms.
4. You may send your proof of payment via email to accounting@isacenter.org, or on site during the Boot Camp.
5. Deadline of submission of proof of payment is on February 21, 2020. You may opt to settle your payments onsite. Payments made after will be subject to an administrative fee of PHP 200 per organization.
6. No-show fee: An amount of 100% of the regular participation fee will be charged to those who submit a registration form but do not attend the Boot Camp.
7. Cancellations of registration can be requested and will be given a full refund before January 24, 2020 and a 50% refund before February 7, 2020. Any request for refund or cancellation after February 7 will not be acknowledged.
8. ISA reserves the right to cancel and/or postpone the event due to unforeseen circumstances or if the target number of participants isn't reached. Also, program changes may occur without prior notice.
Do you agree with the terms and conditions?*

Yes, I would like to submit my registration form.
Sex*

MaleFemaleOther
Birthday*
(e.g. April 18, 1972)
T-Shirt Size*
Transportation Details
Transportation Mode*
Please indicate if you are traveling via bus or airplane (include bus line, e.g. Victory Liner and airline e.g. Philippine Airlines) or if you are taking your own vehicle.
Estimated Time of ARRIVAL (ETA) in Iloilo City*
Note that you have Day 0 accommodation on February 18 (Tues). Day 0 registration and check-in is at 2:00pm.
Estimated Time of DEPARTURE (ETD) from Iloilo City*
The program on the last day (February 21, Friday) will end at 1:30pm.
Accommodation Arrangements

You may choose to share a twin-sharing room with a fellow Boot Camp participant or bring your own companion and pay for the full accommodation rate indicated below. Extra rooms are subject to availability.
Rooming Disclaimer

Please note that rooms will be reserved upon the submission of the registration form. In the event that the hotel gets overbooked and can no longer provide rooms for late registrants, we shall billet them in a hotel near the venue.
Courtyard by Marriott, Iloilo

Twin sharing with a fellow Boot Camper (with preferred roommate)Twin sharing with any fellow Boot CamperSingle room (additional Php 1,900/night, subject to availability)Other (Please contact Glydelle Amon)
Preferred Roommate (if any)
Relationship with non-delegate Companion/s (if applicable)
Only fill this out if you plan on bringing a companion who won't participate in the Boot camp.
Contact in Case of Emergency
Full Name*
Relationship*
Contact Number*
Release and Waiver of All Claims
1. I understand that my request for changes in rooming arrangements, if granted, is non-refundable, and must be paid to ISA before the end of my stay.
2. I understand that I will be releasing ISA from any liability, claims, and demands of whatever kind of nature, either in law or equity, which arise or may hereafter from my participation in the 21st Governance Boot Camp.
3. I understand that ISA will not have any obligation to provide me with financial or other assistance, including but not limited to medical, health, or disability insurance of any nature in the event of any losses or accidents which may happen to me during the 21st Governance Boot Camp.
Do you agree with the clauses stated above?*

This form was last updated at 7:58am on 10 August 2017.
See you at the 21st Governance Boot Camp!

For any questions or concerns, please contact:

Lisette Dimalanta

ldimalanta@isacenter.org | (02) 886-3652 loc. 103

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21st Governance Boot Camp: Basic Class

Transportation Details

Accommodation Arrangements

Rooming Disclaimer

Contact in Case of Emergency