By SERELY GERALDINE D. ALCARAZ - Leadership and ...

(Please make copies of this page for registration as required)
Event Fees and General Information
20th - 21st DECEMBER 2012, HOTEL INTERCONTINENTAL, PHNOM PENH, CAMBODIA
VAT is excluded.
Participation Options:
Gold Package USD 1,500.00
The Benefits:
3 complimentary registrations for the event, name and logo of sponsor will be promoted on program information website and program
materials (black and white) + 2 issues of inside full page advertising on KISS Mag.
Platinum Package USD 2,900.00
The Benefits :
6 complimentary registrations for the event, name and logo of sponsor promoted on program website, back drop (color) and program
materials (black and white). One exhibition table for p romotion during the event + 4 issues of inside full page advertising on KISS Mag.
Payment details
Payments may be made by telegraphic transfer, bank deposit or local check
Account name (Pay to) : LEADERSHIP AND DEVELOPMENT CENTER
Account Number : 2224509
Name of Bank : ANZ ROYAL BANK
Address : PHNOM PENH, CAMBODIA
Please tick : Super Early Bird Fee Early Bird Fee Regular Fee Gold Package Platinum Package
Title and name: P rof / Dr / Mr / Mrs / Ms
Phone no. Fax no. Email
Mobile no. Position
Organization
Address
Event Fees International
Super Early Bird Fee –
First Registrations with Payment before 01 Nov 2012 USD 389.00
Early Bird Fee –
Second Registrations with Payment before 30 Nov 2012 USD 430.00
Normal Fee –
After 01 Dec 2012 USD 490.00
Date Signature
Mode of Registration:
LEADERSHIP AND DEVELOPMENT CENTER (LDC)
Tel : + (855-23) 555 0505
H/P: + (855-77) 861 168 / 010 666 619 Kent
H/P: + (855-77) 777 098 / 069 222 234 Ratha
Fax: + (855-23) 224 598
E-mail: training@ldcasia.com / kent@ldcasia.com
REGISTRATION FORM
LDC
LEADERSHIP AND
DEVELOPMENT CENTER
PEOPLE - ORIENTED DEVELOPMENT
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