FIRST NAME: _______________________________ LAST NAME: ________________________________

MIDDLE NAME: _____________________________ BIRTHPLACE: _______________________________

NATIONALITY: ______________________________ GENDER: _____________________
CIVIL STATUS: _______________________ BIRTHDATE: MONTH: _________

DAY: ____ YEAR: ______

E-MAIL: ___________________________________________________ LANDLINE NO.:_________________

MOBILE NO.: _____________________________ MAILING ADDRES:

____ HOME

___OFFICE

HOME ADDRESS: (BUILDING NAME/HOUSE NO., ST., SUBDIVISION/VILLAGE, CITY, PROVINCE, ZIPCODE)
__________________________________________________________________________________________
__________________________________________________________________________________________
PROVINCE: __________________________ CITY: _______________________ BARANGAY:_____________
DO YOU WANT TO HAVE AN E-COMMERCE SITE? __ YES __ NO
IF YES, PLEASE FILL IN BELOW: (*REQUIRED)
*BUSINESS NAME: _____________________________________________________________________
*NATURE OF BUSINESS: (PLEASE SELECT ONE)
___ RETAILERS

___ ARTISTS/CRAFTSMEN ___TRAVEL

___ MANUFACTURERS

___ HOSPITALITY

___ SOLUTIONS PROVIDER __ SERVICES

___ FOOD MAKERS

___ ENTREPRENEURS

___ OTHERS, PLEASE SPECIFY: ____________

*BUSINESS ADDRESS: (BUILDING NAME/HOUSE NO., ST., SUBDIVISION/VILLAGE, CITY, PROVINCE, ZIPCODE)
__________________________________________________________________________________________
__________________________________________________________________________________________
*TIN/SSS/UMID: ______________________________ MAYORS PERMIT NUMBER: _____________________
DTIS BUSINESS PERMIT NUMBER: _______________
STORE NAME: _________________________________________

BUSINESS OWNER(S) NAME: ___________________________________

BUSINESS OWNER(S) BIRTHDATE: MONTH: _________

DAY: ____ YEAR: _____

*BUSINESS E-MAIL: __________________________________

*PICK-UP ADDRESS: (BUILDING NAME/HOUSE NO., ST., SUBDIVISION/VILLAGE, CITY, PROVINCE, ZIPCODE)
__________________________________________________________________________________________
__________________________________________________________________________________________

*CONTACT PERSON: _________________________________

*CONTACT PERSON PHONE NUMBER: ____________________________________
*WHERE DID YOU LEARN ABOUT UREKA FORUM:
___ SOCIAL MEDIA (FACEBOOK, TWITTER, INSTAGRAM)
___ TRADITIONAL MEDIA (TV, RADIO, BILLBOARD, NEWSPAPER)
___ DIGITAL ADS
___ REFERRED BY CHAMBER OF COMMERCE
___ REFERRED BY JANETTE TORAL
___ OTHERS, PLEASE SPECIFY: ___________________

DO YOU WANT TO BE AN EXHIBITOR? __ YES ___ NO

GUIDELINES:
1. Exhibitor must register to the Ureka Forum and the E-commerce circuit
2. Each exhibitor is entitled to a 3 meters x 3 meters booth during the forum and must be able to bring in
products to fill the area provided.
3. Each booth will be provided with sockets.
4. Cooking is not allowed at the venue.
5. Every business is entitled to maximum of two companions ONLY.
6. Exhibitor is responsible for the sales and marketing of products/services during the Ureka Forum.
TERMS AND CONDITIONS:

A. Registration Process and Payment Methods

1) Registrants may avail early bird fee of PHP 400.00 up until 23:59 September 25, 2015.
2) Ureka Forum registrations will not be confirmed until the completed form and the correct payment is
received and processed by the Registration committee
3) Registrants should obtain confirmation sent via email by the Ureka organising team.
4) The Ureka Forum will not be responsible for your spam filters blocking your confirmation email. Please
ensure your spam filters will allow mail from Ureka Forum.
5) Accommodation costs are not included in the conference registration fee. Attendees coming from
neighbouring cities are responsible for arranging their own lodging and transportation.
6) Capacity is 500 attendees. Registrations will be handled on a first-come, first-served basis.
7) Payment for on-site registration must be made in CASH (PHP 600.00)
8) All payments are inclusive of AM snack, lunch, and PM snack.

9) The first 150 businesses who qualified for the e-commerce circuit must bring all the necessary
documents indicated in the confirmation e-mail.
a. The Ureka Forum and all its partners are not accountable for the management of the 150 ecommerce sites produced after the forum; nor responsible for sales and marketing initiatives of
the business thereon. All necessary learning materials have been provided to walk businesses
through their e-commerce sites.
b. All businesses qualifying for the e-commerce circuit are required to open a Ureka account which
costs PHP 350.00 to be paid onsite. (WAIVED as of 23 September 2015)
c. Should the business be a partnership or a corporation, parties must agree among themselves
as to whom the Ureka account will be named after.
10) The first 20 businesses who reserved their booths to showcase their products are limited to only 2
companions each.
a. The Ureka Forum and all its partners are not responsible for any loss or damage in products
b. The Ureka Forum and all its partners are not responsible for any loss or damage in products
c. The Ureka Forum is not responsible for transporting products to and from the venue.

B. Cancellation Policy
Ureka Forum registration can be cancelled only in writing to Ureka Customer Service at 6F Cambridge Centre
Building, 108 Tordesillas cor. Gallardo Sts., Salcedo Village, Makati City.
1. Registration cancelled on or before September 18 will be entitled to a 50% refund. Registration
cancelled after September 18 will not be entitled to a refund.
2. Participant substitution may not be made at any time.
3. All refunds will be made after the conference within two months.
C. Personal Information
1. Please note that participant contact details will be kept on the Ureka Forum database, which will only be
used by Ureka and its partners. Credit card information will NOT be stored in this database.
2. The e-mail addresses will also be used to circulate last minute details and announcements of future
Ureka events.
D. Personal Property
Ureka Forum accepts no responsibility for loss or damage to personal property.