Republic of the PhilippinesProvince of Benguet

MUNICIPALITY OF BOKOD

1st Mt. Purgatory Mangisi Traverse“A Traverse for Environmental

Awareness, Promotion & Protection”

Registration Form Name: ________________________________________________________________________________ Surname First Name Middle Name Nickname: ___________ Age: ____ Gender: _____ Religious Affiliation : ________________________

Address: _________________________________________________________________________________ No. of Street/Barangay City/Town Province (State) Country

Date of Birth : __________________ Occupation : _____________ Cellphone Number: _______________ Month - Date - YearName and Address of Organization (if any) : ___________________________________________________Person to Contact in case of Emergency : Name : ______________________________________________ Relationship : _______________Address : ____________________________________________ Contact Number : _______________Do you need a porter ? Yes _______ No _______ If yes, how many ? ______________

WaiverI am joining the “1st Mt. Purgatory Mangisi Invitational Traverse” in Bokod, Benguet

scheduled on April 13 - 15 , 2012 on my free will and I solely and exclusively assume all risk and dangers which I may be exposed to for the duration of the activity and I therefore discharge, waive and absolutely extinguish the organizers and all its cooperation agencies/entities from any responsibility.

Correspondingly, I hereby grant permission to the cooperating organizers to use my name , likeness and identity in any photographs , motion pictures, television programs , or any other record of the event in perpetuity throughout the world in any media now known or hereafter developed.

__________________________________________ Participant’s Signature and Date Accomplished

Registration Fee : P 1,500.00 (Inclusive of transportation (vice versa), t-shirt, souvenir items, certificate, dinner on the two nights and lunch on the third day).

Porters Fee : P 500.00 per day (not included in the registration fee, prior reservation is necessary with a maxi- mum load of 25 kilograms).

What to Bring : Tent , sleeping bag, food (3 meals), trail foods, cooking sets, flashlight/headlamps, extra batteries, first aid kits, garbage bag, water and water container, raincoats (for unexpec- ted rain showers) and other mountaineering gears.

* Payments can be made at the Bokod Municipal Tourism Office, Poblacion, Bokod, Benguet or at the Provincial Tourism Office, Benguet Capitol, La Trinidad, Benguet.

For more information and inquiries, visit or contact : Bokod Municipal Tourism Office – Cell # 09499757459 – Email Add: mtpurgatorybokod@yahoo.comProvincial Tourism Office, Capitol, La Trinidad, Benguet – Telefax # : (074) – 422 – 1116.

Republic of the PhilippinesProvince of Benguet

MUNICIPALITY OF BOKOD

1st Mt. Purgatory Mangisi Traverse“A Traverse for Environmental

Awareness, Promotion & Protection”