• PHILIPPINE SOCIETY OF CLINICAL NEUROPHYSIOLOGY

    PHILIPPINE SOCIETY OF CLINICAL NEUROPHYSIOLOGY

    Member, Asia-Oceania Chapter of the International Federation of Clinical Neurophysiology

  • OFFICIAL MEMBERSHIP APPLICATION FORM

    Estimated fill-up time: 10-15 minutes

  • Welcome to the Philippine Society of Clinical Neurophysiology!

    For best experience, fill up this form using a laptop or desktop. A mobile phone can also be used but the alignment/margins might vary per device.

    INSTRUCTIONS

    1. Please read the membership classification criteria carefully and choose the type of membership appropriate for your background.
    2. Please prepare your documents (CV, ID picture, PRC, training certificates, etc.) These files are preferably in JPG, PNG or PDF format. 
    3. Take note of membership fees for your category. Online payment options are available for your convenience.
    4. Once submitted, your application will be processed within 24-48 hours. Expect an email response from our team confirming your application. 
    5. For any questions or queries, please feel free to communicate with us via email (philneurophysio@gmail.com) 

  • MEMBERSHIP APPLICATION*

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              FELLOW MEMBER

              Physicians who are board-certified in Neurology with a certified subspecialty training in Clinical Neurophysiology

              1,500.00 PHP1,500.00PHP
                
              ACTIVE MEMBER

              Physicians without Neurology training (e.g internist, physiatrist, pulmonologist) but with a certified subspecialty training in Clinical Neurophysiology

              1,000.00 PHP1,000.00PHP
                
              ASSOCIATE MEMBER

              Physicians (neurologists or non-neurologists) without subspecialty training in Clinical Neurophysiology but with a special interest in the field

              750.00 PHP750.00PHP
                
              JUNIOR MEMBER

              Physicians in training (residency) with a special interest in Clinical Neurophysiology

              Free FreePHP
                
              AFFILIATE MEMBER

              Technicians or Ancillary Staff with a special interest in Clinical Neurophysiology

              500.00 PHP500.00PHP
                

            • PERSONAL DETAILS

            • Gender*
            • Birthday:*
               / /
              2 digit month, 2 digit day, 4 digit year
            • DOCUMENT REQUIREMENT: Please upload an image (in JPG/PNG/PDF format) of your updated PRC license by clicking on the box below (if no PRC, please attach your affiliated institution's ID:*
            • Format: (0000) 000-0000.

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            • PROFESSIONAL DETAILS

            • DOCUMENT REQUIREMENT: Please upload an image (in JPG/PNG/PDF format) of your neurology residency completion certificate by clicking on the box below:*
            • DOCUMENT REQUIREMENT: Please upload an image (in JPG/PNG/PDF format) of your certificate of ongoing training signed by training officer or chair of your institution by clicking on the box below:*
            • DOCUMENT REQUIREMENT: Please upload an image (in JPG/PNG/PDF format) of your fellowship training completion certificate by clicking on the box below:*

            • CONFORME

            • I hereby certify that the information provided above is true and accurate to the best of my knowledge. The information I provided will be the basis for evaluating my application to the Philippine Society of Clinical Neurophysiology.

            • PAYMENT FOR MEMBERSHIP FEE

              Please take note of the fees for your chosen membership category:

              Fellow Member - P1,500.00
              Active Member - P1,000.00
              Associate Member - P750.00
              Affiliate Member - P500.00
              Junior Member - Free (but with certificate of training)

               You may submit payment (via online transaction or bank deposit)

              PHILIPPINE SOCIETY OF CLINICAL NEUROPHYSIOLOGY, INC.
              Banco De Oro, St Lukes BGC Branch
              Acct No 0070 - 1801 - 0641

              Please attach screenshot/image of proof of payment below, or alternatively you can email it to philneurophysio@gmail.com 

              Please also indicate your name during the transfer (add notes to online payment)

            • DOCUMENT REQUIREMENT: Please upload a screenshot (in JPG/PNG/PDF format) of your proof of payment by clicking on the box below:*

            • Acknowledgement receipt will be provided once your information has been processed by the society. An official receipt will follow as well.


              PLEASE REVIEW YOUR INFORMATION

              If everything is correct and complete, click the SUBMIT APPLICATION FORM below to finalize your membership application.

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