Title

Mr. Ms.

Name

            
Last Name                First Name               Middle Initial

Participant

    Private   (P4,000.00)
    Government (P3,000.00)
      Student
    with meals  (P2,500.00)
    w/o meals   (P800.00)

Age bracket:

  Below 20
  20 to 39
  40 to 59
  60 and over

Official Designation

Name of Agency

Address of Office

Phone Number

Attended 8th Convention in October 2001?

     Yes

     No

E-mail Address

Payment mode:
   Cash  (to be delivered/sent to NSCB)
   Check (payable to National Statistical Coordination Board)
         Check no. Branch:    Date:  
   Bank (DBP all branches - account number: 0-05587-405-4)
         Branch: Date:

10% discount for early individual registration on or before August 31, 2004

15% discount for early group registration (minimum of 5 persons) on or before Aug 31, 2004