4th National Advisory Council Summit

“Strengthening Partnerships for Genuine Transformation”

The Monochrome Events Place, Nuvali, Sta. Rosa City, Laguna
2X2 ID
November 14-17, 2018 PICTURE

DELEGATE INFORMATION SLIP

Title First Name Middle Name Last Name Qualifier (Jr, Sr.)

Office/Organization: Position/Designation:

Sectoral Representation, Please Check:

____________ Business ____________ Local Government Unit Civil Society:
____________ Academe ____________ Non-Government Organization ______ Youth
____________ Judiciary ____________ National Government Agency ______ Women
____________ Religious ____________ Media ______ Senior
____________ NAPOLCOM ______ LGBT
Mobile Number: Email:

Nickname: Birthday:

To those who will travel via airplane, please indicate itinerary:

Origin ____________ Destination____________

Date: ____________ Airline: ____________ Date: ____________ Airline: ____________

Flight # ____________ ETD: ____________ Flight # ____________ ETD: ____________
ETA: ____________ ETA: ____________
To confirm the above mentioned information, kindly write your name below as you would like it to appear on your
certificate:
________________________________
(Example: Mr. Juan M. Dela Cruz)

DIETARY RESTRICTIONS / FOOD ALLERGIES / RELEVANT MEDICAL CONDITIONS:

PLEASE CHECK IF YOU ARE JOINING THE ACTIVITIES FOR NOVEMBER 14, 2018 AT ENCHANTED KINGDOM:

I WILL AVAIL OF THE TICKET FOR THE RIDES AT ENCHANTED KINGDOM (2:00PM – 6:00PM): __________
I WILL NOT AVAIL OF THE TICKET FOR THE RIDES AT ENCHANTED KINGDOM: __________

I WILL JOIN THE DINNER AT ENCHANTED KINGDOM (6:00 PM – 9:00PM): ____________

I will NOT JOIN THE DINNER AT ENCHANTED KINGDOM: ____________

PLEASE CHECK RECREATIONAL ACTIVITY FOR November 17, 2018 (0600- 1200H)
IF YOU WILL JOIN, CHOOSE ONLY ONE ACTIVITY:

I will JOIN: ___________ ___________ City Tour (PNPA, Sky Ranch, Picnic Groove)
I will NOT JOIN: ___________ ___________ Golf Tournament (Nuvali Area)

* Please email (oad@cpsm.pnp.gov.ph AND oad@pnp.cpsm.ph) this form to us by October 5, 2018 in order avoid
delays in the processing of your registration

* Please be informed that NO addtional provisions/accomodations will be provided to companions of the attendees (e.g. driver,
security, etc).

* Contact CPSM Secretariat, SPO2 Fermin A Mopal (02-411-6845/0906-300-0029) for further inquiries.

PNP Vision...highly capable, effective and credible police service.