60th PPS Pre-Convention "*" indicates required fields Step 1 of 3 33% Type of Delegate*Convention AttendeeOrganizing Committee MemberBoard of TrusteePast National PresidentChapter PresidentPast Chapter PresidentSubspecialty Society PresidentSpeakerPPS Membership Status* Emeritus Fellow Fellow Diplomate Select one (1) Pre-convention Module that you will attend* Module 1: Researcher Module 2: Clinician Module 3: Manager Module 4: Educator Module 5: Social Mobilizer Select Pre-convention Module/s that you will attend Module 1: Researcher Module 2: Clinician Module 3: Manager Module 4: Educator Module 5: Social Mobilizer Select All Contact DetailsName*(as it appears on your PRC Card) First Middle Last PRC Number* Put N/A if foreign delegatePRC Expiry Date* MM slash DD slash YYYY Birth Date* MM slash DD slash YYYY Phone Number*Email* Enter Email Confirm Email Which HAB Training Institution do you represent?*—Others—Adventist Medical Center ManilaAmang Rodriguez Memorial Medical CenterAsian Hospital & Medical CenterCapitol Medical CenterCardinal Santos Medical CenterChinese General Hospital and Medical CenterDe Los Santos Medical CenterDr. Jesus Delgado Memorial HospitalDr. Jose N. Rodriguez Memorial Hospital and SanitariumEast Avenue Medical CenterFatima University Medical CenterFe Del Mundo Medical CenterFEU-NRMFHospital of the Infant JesusJose Fabella Memorial HospitalJose Reyes Medical CenterLas Piñas Doctors HospitalLas Piñas General Hospital & Satellite Trauma CenterMakati Medical CenterMandaluyong City Medical CenterManila Doctors HospitalMary Chiles General HospitalMary Johnston HospitalMCU-FDTMFMedical Center ManilaMedical Center ParañaqueMedical Center Muntinlupa, Inc.Metropolitan Medical CenterNational Children’s HospitalOspital ng MakatiOspital ng MuntinlupaOur Lady of Lourdes HospitalPasay City General HospitalPasig City General HospitalPerpetual Help Medical Center – Las PiñasPhilippine Children’s Medical CenterPLM-Ospital ng Maynila Medical CenterQuezon City General HospitalQuirino Memorial Medical CenterRizal Medical CenterSan Juan De Dios HospitalSan Juan Medical CenterSt. Luke’s Medical Center- Global CitySt. Luke’s Medical Center-Quezon CityThe Medical CityTondo Medical CenterUERM- Medical CenterUP-PGH HospitalUST HospitalVeterans Memo Medical CenterVRP Medical CenterValenzuela Medical CenterVictoriano Luna Medical CenterWorld Citi Medical CenterPhilippine Heart CenterResearch Institute for Tropical MedicineCagayan Valley Medical CenterRegion II Trauma and Medical CenterSouthern Isabela Medical CenterMariano Marcos Memorial Hospital & Medical CenterIlocos Training & Regional Medical CenterBaguio General Hospital & Medical CenterSacred Heart Medical CenterRegion I Medical CenterAngeles University Foundation & Medical CenterJames L. Gordon Memorial Medical CenterJose B. Lingad Memorial General HospitalTarlac Provincial HospitalDr. Paulino J. Garcia Memorial Research & Medical CenterBulacan Medical CenterCentral Luzon Doctors HospitalBataan General Hospital and Medical CenterJecsons Medical CenterDe La Salle University Medical CenterGen. Emilio Aguinaldo Memorial HospitalPerpetual Help Medical Center-BiñanBatangas Medical CenterMary Mediatrix Medical CenterBicol Medical CenterBicol Regional Training & Teaching HospitalCebu City Medical CenterCebu Doctor’s University HospitalCebu Velez General HospitalChong Hua HospitalChong Hua Hospital-MandaueVisayasMed HospitalPerpetual Succour HospitalSouthwestern University Medical CenterVicente Sotto Memorial Medical CenterSilliman University Medical CenterGov. Celestino Gallares HospitalUniversity of Cebu Medical CenterAllied Care Expert (ACE) Medical Ceenter-TaclobanDivine Word HospitalEastern Visayas Medical CenterRemedios Trinidad Romualdez HospitalAdventist Med. Ctr. – BacolodCorazon Locsin Montelibano Memorial HospitalDr. Pablo O. Torre Sr. Memo HospitalThe Doctor’s HospitalIloilo Doctor’s HospitalIloilo Mission HospitalSt. Paul’s HospitalWest Visayas State University Medical CenterWestern Visayas Medical CenterBrokenshire Integrated Health MinistriesCotabato Regional & Medical CenterDavao Doctor’s HospitalDavao Medical School Foundation HospitalDavao Regional Medical CenterMetro Davao Medical and Research Center, Inc.San Pedro HospitalSt. Elizabeth Hospital, Inc.Southern Philippines Medical CenterAdventist Medical Center-IliganMa. Reyna Xavier University HospitalNorthern Mindanao Medical CenterAmai Pakpak Medical CenterZamboanga City Medical CenterNon HAB Hospital (optional)* Put your Hospital if you select “Others” in HAB Training InstitutionPosition* Chair Training Officer Consultant Other Chapter*National Capital RegionNortheastern Luzon ChapterNorthern Luzon ChapterCentral Luzon ChapterSouthern Tagalog ChapterBicol ChapterCentral Visayas ChapterEastern Visayas ChapterNegros Occidental ChapterWestern Visayas ChapterDavao/Southern Mindanao ChapterNorth Central Mindanao ChapterSouthwestern Mindanao Chapter Transaction DetailsPre-Convention Fee Price: Total As Organizing Committee Member, you are exempted for the pre-convention registration, kindly click the submit button. As VIP, you are exempted for the payment, kindly click the submit button. As Speaker, you are exempted for the payment, kindly click the submit button. Participant Early Registration (December 1, 2022 – March 15, 2023 Regular (March 16, 2023 – April 30, 2023) Pre-Convention P1,000 P1,500 Payment Option*Please choose your payment optionAlready paid at PPS OfficeBank Transfer or Bank DepositPre-Convention Transaction Number* Amount Paid* Convention Transaction Date* MM slash DD slash YYYY Proof of payment*Attach your official receipt or deposit slip Drop files here or Select files Accepted file types: jpg, png, pdf, Max. file size: 5 MB, Max. files: 3. HiddenPAYMENT VERIFICATIONFor Internal Use OnlyFor VerificationPaid and Confirmed – DelegatePaid and Confirmed – VIPHiddenVERIFIED BYPayment is verified by? HiddenDATE VERIFIEDWhen was the payment verified? MM slash DD slash YYYY EmailThis field is for validation purposes and should be left unchanged. Δ
