Onsite Registration

Please enter information in the form below to process registration for the TEST Annual Convention.

PCEDM Membership *

Member

Non-Member

Email *

Last Name *

First Name *

Middle Name *

Profession *

RND

Others

Others *

Mobile Number *

PRC License Number *

Note: For PRC Number, please enter 7-digit PRC number. If you're PRC number has less than 7 digits, please add zero/es in front.

Ex. PRC No.: 12345 should be entered as 0012345. Please enter 0000000 if you don't have PRC number.

PRC Expiry Date (MM/DD/YYYY) *

Are you a Senior Citizen/PWD? *

Yes (Senior Citizen/PWD ID photo required)

Registration Fee *

PCEDM Member (₱ 5,000.00)

Non-PCEDM Member (₱ 6,000.00)

Fellow-in-training/Resident-in-training (₱ 3,500.00)

Allied Health Care Professional (RN, RND, RMT, RM, etc.) (₱ 3,000.00)

Registration Fee *

PCEDM Member (₱ 4,000.00)

Non-PCEDM Member (₱ 4,800.00)

Fellow-in-training/Resident-in-training (₱ 2,800.00)

Allied Health Care Professional (RN, RND, RMT, RM, etc.) (₱ 2,400.00)

Kindly upload the front page of your Senior Citizen/PWD ID *

Amount

₱

Payment Method

Bank Transfer/Cash Payment (Onsite)

Credit Card Number*

Expiration Date*

Card (CVV) Code*

Card Holder Name*

Please check to confirm *

I have reviewed all the information above and confirm that it is correct.

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