John Maxwell Video Broadcast Fill-up Form

[ ] Yes, I would like to avail of the special group promotions. I would like to reserve ___ seats.
[ ] Yes! Please reserve ____ seat(s) for the following participants: (Please change if different)

[ ] Sponsor/VIP Seats [ ] Orchestra [ ] Lodge [ ] Balcony

COMPANY / ORGANIZATION _________________________________________________________
ADDRESS _________________________________________________________________________
TELEPHONE # _________________________________ FAX # ______________________________
EMAIL WEBSITE ___________________________________________________________________
RESERVING OFFICER'S NAME & DESIGNATION ___________________________________________
RESERVING OFFICER'S CONTACT & # EMAIL ____________________________________________
COMPANY TIN # ___________________________________________________________________

PARTICIPANT 1 [ ] MR [ ] MS [ ] MRS [ ] DR [ ] PROF
LAST NAME ____________________ FIRST NAME ____________________ MIDDLE NAME _______
NICKNAME ___________________________________ DESIGNATION ________________________
CONTACT # __________________________________ FAX # _______________________________
MOBILE # ____________________________________ EMAIL ______________________________

PARTICIPANT 2 [ ] MR [ ] MS [ ] MRS [ ] DR [ ] PROF
LAST NAME ____________________ FIRST NAME ____________________ MIDDLE NAME _______
NICKNAME ___________________________________ DESIGNATION ________________________
CONTACT # __________________________________ FAX # _______________________________
MOBILE # ____________________________________ EMAIL ______________________________

* For more than 2 pax, kindly copy-paste to add more. Thank you.
* Mobile# is optional but important in case we need to confirm or inform delegates of urgent, last minute changes in case of emergencies (ie. weather, speaker changes, etc).

KINDLY SELECT ONE OF THE FOLLOWING PAYMENT METHODS:
[ ] By Cheque. I will send check payment to your office on ____________________________.
[ ] By Pick-up. Please pick-up our check on ______________________________ (time/date).
Made payable to Salt and Light Ventures, Inc.
[ ] By Bank Deposit. Kindly remit the money to the ff. bank details:
Company Name: Salt and Light Ventures, Inc.
TIN #: 212-844-982-000-VAT
Account #: BPI CA#3211-0837-85, Paseo de Roxas, Makati Branch

For zero rated or VAT exempt companies, please include your Certificate of Exemption. Provide Form 2307 or Certificate of Tax Withheld if payment done with tax withheld. Please withhold only 2% as we are classified as suppliers or contractors of services.

Source: jmax08videobroadcast-july29-june 10 delegates-philamlife 0714
TERMS:
1. No cancellations seven days before the seminar. Seminar participation may be transferred to another person in the same company.
2. This reservation form, when completed, may also serve as your billing invoice.
3. All seminar fees must be prepaid.