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PSDBP 9th Biennial Convention Registration Form
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* Indicates required question
Mailing Address
*
Your answer
FULL NAME (as it shall appear on the Certificate of Attendance)
*
Your answer
Contact Number (Mobile, Landline, etc.)
*
Your answer
Email Address
*
Your answer
Institution/ Hospital/ Center
Your answer
Designation
*
Choose
MD
Occupational Therapist
Physical Therapist
Speech Therapist
Psychologist
Educator
Social Worker
Parent
Others
Mode of Payment
Bank transfer details:
Account Name: BDO Checking Account – Taft-Vito Cruz Branch
Checking Account Number 00 458 8014 191
Account Name: Philippine Society for Developmental and Behavioral Pediatrics, Inc.
Mode of Payment
*
Pre-registration (On or before July 31, 2017) : PHP 4,500. Pls forward the deposit slip with your name on it to
psdbp2017convention@gmail.com
Advance Registration (After July 31, 2017): PHP 5,000. Pls forward the deposit slip with your name on it to
psdbp2017convention@gmail.com
Bank Deposit Reference Number (or Date and Time of Bank Transaction)
*
Your answer
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