WELCOME LOCAL DELEGATES!
IMPORTANT REMINDERS: Before proceeding with the registration form, please ensure you have a soft copy of your proof of payment in JPEG/JPG or PNG format ready. Details of the proof of payment should be filled in the form below. You will need to upload it as part of the registration process. Thank you!
Back
Next
LOCAL DELEGATES REGISTRATION FORM
FULL NAME
*
Prefix
First Name
Middle Name
Last Name
Suffix
EMAIL
*
example@example.com
Cellphone Number
*
Please enter a valid cellphone number.
PRC LICENSE NUMBER
*
PRC LICENSE EXPIRY DATE (DD/MM/YYYY)
*
/
Day
/
Month
Year
Date
MEMBERSHIP
*
Fellow
Diplomate
Associate
Resident-In-Training
PARM CHAPTER
*
N/A for Residents
NCR
Stars
North Luzon
Visayas
Mindanao
INSTITUTION (FOR RESIDENTS ONLY)
CSMC - Cardinal Santos Medical Center
OSMAK - Ospital ng Makati
POC - Philippine Orthopedic Center
SLMC - St. Lukes Medical Center (QC)
TMC - The Medical City (Pasig)
UP-PGH - Philippine General Hospital
USTH - University Santo Tomas Hospital
VMMC - Veterans Memorial Medical Center
VLMC - Victoriano Luna Medical Center
Dietary Requirements
*
None
Vegetarian
Halal
Senior Citizen ID #
PWD ID #
REGISTRATION FEE
*
prev
next
( X )
EARLY BIRD RATE
October 15, 2024 until December 15, 2024
Free
PHP
CATEGORY
Please select
Speaker
Organizing Committee
Senior
PWD
Fellow
Diplomate
Associate
Resident-In-Training
REGULAR RATE
December 16, 2024 until January 20, 2025
Free
PHP
CATEGORY
Please select
Speaker
Fellow
Diplomate
Associate
Resident-In-Training
ON-SITE
February 20-23, 2024
Free
PHP
CATEGORY
Please select
Fellow
Diplomate
Associate
Resident-In-Training
PLEASE UPLOAD YOUR PROOF OF PAYMENT HERE
*
Back
Next
Submit
Should be Empty: