Philippine League of Secretaries to the Sanggunian, Inc.

(PLEASES)
REGISTRATION/CONFIRMATION FORM
1st National Executive Board Meeting and Seminar-Workshop
on Local Health Policy Legislation Amidst Changing Global Lifestyles
Roxas City, Capiz = March 3 to 6, 2010

Note: This will also serve as your updated Membership Data Form so please accomplish completely and legibly. Thank you.

NAME : _________________________ _______________________ ________________________

(first) (middle) (last)
DESIGNATION : ____ Secretary to the Sanggunian ___ Assistant Secretary to the Sanggunian
____ Acting/OIC Secretary to the Sanggunian ___ Others: Please specify
__________________________________
LGU : Municipality ________________________ (or) City ___________________________________
Province ___________________________ Region _________________________________
Office Address ___________________________________________________________________
APPOINTMENT DATE: (as Secretary or Assistant Secretary)______________ BIRTHDATE : (mm/dd/yy) _____________
SEX : _____ Male _____ Female
CIVIL STATUS : _____ Single _____ Married _____ Widow/Widower _____ Separated/Annulled
CONTACT DETAILS: Mobile Phone Nos. ________________________________ Telephone Nos. ____________________
E-mail address _____________________________________ Fax Nos. __________________________
Contact in case of emergency - Person: ________________________Relationship: _________________
- Address: _____________________Contact No. ________________
WILL YOU JOIN THE ECO-TOUR TO BORACAY ISLAND, MALAY, AKLAN? ______ YES _____ NO

___________________________________________
(signature over printed name)

----------------------------------------------------------------------------------------------

Philippine League of Secretaries to the Sanggunian, Inc. (PLEASES)

REGISTRATION/CONFIRMATION FORM
1st National Executive Board Meeting and Seminar-Workshop
on Local Health Policy Legislation Amidst Changing Global Lifestyles
Roxas City, Capiz = March 3 to 6, 2010

Note: This will also serve as your updated Membership Data Form so please accomplish completely and legibly. Thank you.

NAME : _________________________ _______________________ ________________________

(first) (middle) (last)
DESIGNATION : ____ Secretary to the Sanggunian ___ Assistant Secretary to the Sanggunian
____ Acting/OIC Secretary to the Sanggunian ___ Others: Please specify
__________________________________
LGU : Municipality ________________________ (or) City ___________________________________
Province ___________________________ Region _________________________________
Office Address ___________________________________________________________________
APPOINTMENT DATE: (as Secretary or Assistant Secretary)______________ BIRTHDATE : (mm/dd/yy) _____________
SEX : _____ Male _____ Female
CIVIL STATUS : _____ Single _____ Married _____ Widow/Widower _____ Separated/Annulled
CONTACT DETAILS: Mobile Phone Nos. ________________________________ Telephone Nos. ____________________
E-mail address _____________________________________ Fax Nos. __________________________
Contact in case of emergency - Person: ________________________Relationship: _________________
- Address: _____________________Contact No. ________________
WILL YOU JOIN THE ECO-TOUR TO BORACAY ISLAND, MALAY, AKLAN? ______ YES _____ NO

________________________________
(signature over printed name)