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    Professional Certificate in Business Model Innovation

    Registration Form • Online Learning Program

    PERSONAL DATA

    Surname *

    First Name *

    M.I. *

    Nickname *

    Birthday* For others, use YYYY-MM-DD format

    Mobile Number *

    Personal Email *

    Preferred Mailing Address *

    Postal Code *

    EMPLOYMENT INFORMATION

    Company Name

    Position

    Company Email

    Office Number

    Company Address

    Postal Code

    ACADEMIC QUALIFICATION

    University *

    Course *

    Year Graduated

    HOW DID YOU LEARN ABOUT THIS PROGRAM?

    EMAIL DIRECT MAIL WEBSITE OTHERS

    PROGRAM FEE

    Regular Rate: Php 4,800

    (Note: All program fees are net of all applicable taxes.)

    DATA PRIVACY

    Upon signing this form you are agreeing that the personal data obtained from the registration form entered and stored within the Institute’s authorized information and communications system and will only be accessed by the CIE authorized personnel. Furthermore, the information collected and stored in this form shall only be used for the following purposes:

    • Announcements / promotions of events, programs, courses and other activities offered / organized by the Institute and its partners;

    • Activities pertaining to establishing relations with participants/members/alumni;

    • CIE has the right to share your information to our related affiliate companies, institutions,and or subsidiaries;

    • CIE shall not disclose the participants/members/alumni personal information without their consent and shall retain this information over a period of ten years for effective implementation,research analytics, and management.

    TERMS AND CONDITIONS

    Payment

    Slot will be reserved upon payment of the prescribed fees stated in this Registration Form.

    Refunds, Cancellation and Substitution Policies

    1. Refunds will be honored if we received a written notice of cancellation 30 days prior to the start of the program and must be faxed to 8706-2212 or 8706-4645. Cancellations received less than 30 days prior to the start of the program will be charged 25% of the total program fee while those received one week prior to the start will be charged 50%.

    2. No refund will be made for cancellations received after the stated deadline.

    3. CIE reserves the right to cancel, change venues, and facilitators due to factors beyond our control, and to ensure learning effectiveness. In case of cancellation, seat can be moved to the next batch, or full refunds will be given.

    4. Substitutions for individuals can be made any time prior to event date.

    CONFIRMATION

    I hereby certify that I have read and accepted all the terms and conditions stated in this registration form.

    Digital Signature:*

    Date: *

    NOTE: Confirmation email will be sent to your Personal Email Address.