16th PGS Boot Camp Registration Form

16th Governance Boot Camp
Full name (name to appear on your certificate) *
(e.g. Capt. Juan Dela Cruz)
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.
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 (if you are attending both classes, please tick the applicable boxes) *

BASIC CLASS Regular (PHP 36,000 per pax) BASIC CLASS Group of 5 (PHP 34,000 per pax) MASTER CLASS Regular (PHP 38,000 per pax) MASTER CLASS Group of 5 (PHP 36,000 per pax)
Mode of payment *

Cash Cheque Bank Deposit
Bank Details

Institute for Solidarity in Asia

Land Bank of the Philippines

Sen. Gil Puyat Avenue - Makati City Branch

CA #0052-1410-52
Who can we coordinate with from your office regarding payments? Please indicate their name, designation, email, and contact number. *
Terms and Conditions
1. All fees are inclusive of taxes.
2. Your slot will be reserved upon submission of the proof of payment (cash/cheque/deposit slip).
3. You may send your proof of payment via fax to (02) 886-3652 loc. 116, or via email to jparreno@isacenter.org .
4. Deadline of submission of proof of payment is on September 15, 2017. Payments made after will be subject to an administrative fee of PHP 200 per delegate.
5. An amount of 50% of the REGULAR participation fee will be charged to those who submit a registration form but do not attend the Boot Camp.
6. Cancellations of registration can be requested and will be given a full refund before September 8, 2017, and a 50% refund before September 15, 2017. Any request for refunds or cancellations after September 15 will not be acknowledged.
7. ISA reserves the right to cancel and/or postpone the event due to unforeseen circumstances, and program changes may occur without prior notice.
Do you agree with the terms & conditions? *

Sex *

Male Female
Birthday *
(e.g. April 18, 1972)
T-Shirt Size *
Transportation Details
Transportation Mode *
Please indicate if you are traveling via bus (include bus line, e.g. Victory Liner) or if you are taking your own vehicle. Parking is available at Camp John Hay.
ETA in Baguio City *
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.
The Manor

Twin sharing with a fellow Boot Camper Single room (additional PHP 4,500 per night) Other (please contact Julie Parreño)
Relationship with Companion/s (if applicable)
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 16th 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 16th Governance Boot Camp.
Do you agree with the clauses stated above? *

What do you expect from the Boot Camp? *
What module are you looking forward to the most and why? *
What relevant experiences and/or skills can you share with your fellow Boot Campers? *
Thank you for answering our survey.

See you at the 16th Governance Boot Camp!

For any questions or concerns, please contact:

Julie Mea Parreño

jparreno@isacenter.org | (02) 886-3652 loc. 106
This form was last updated at 7:58am on 10 August 2017.
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16th Governance Boot Camp

Transportation Details

Accommodation Arrangements

Contact in Case of Emergency