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Philippine Society for Developmental and Behavioral Pediatrics (PSDBP)

Philippine Society for Developmental and Behavioral Pediatrics (PSDBP) 6th Biennial Convention: Looking In and Linking Up. REGISTRATION FORM. September 9-10, 2011 EDSA Shangri La Hotel, Mandaluyong City. Please check :. MD. SP. OT. PT. SPeD Teacher.

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Philippine Society for Developmental and Behavioral Pediatrics (PSDBP)

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  1. Philippine Society for Developmental and Behavioral Pediatrics (PSDBP) 6th Biennial Convention: Looking In and Linking Up REGISTRATION FORM September 9-10, 2011 EDSA Shangri La Hotel, Mandaluyong City Please check: MD SP OT PT SPeD Teacher Primary Hospital Affiliation/Therapy Center/School Teacher Parent Other: _________ LAST NAME Primary Practice Address FIRST NAME M.I. PRC NUMBER REGISTRATION FEE: Pre-Registration : Php 3000 On-Site Registration: Php 3500 Deadline for Pre-Registration: June 30, 2011 To Register, call 02-434-3946 or email: devpedphil@gmail.com Manner of Payment: Cash/Personal Check (for Pre-Registration Only) payable to PSDBP Or Deposit to PSDBP current account: BPI Family Bank, P. Tuazon, Cubao Branch (Account # 6015-0599557) For more information: Contact RJ Palor (PSDBP Secretary) +639228019057 or at 02-4343946 4th Floor Philippine Pediatric Society (PPS) Bldg, 52 Kalayaan Avenue, Barangay Malaya, Quezon City Nickname: ________ Specialty ___________ Subspecialty ______ Medical Society/Affiliation: ________________________________ Mailing Address: ________________________________________ ______________________________________________________ Mobile Number ___________________ Landline______________ Email Address: _________________________________________

  2. Philippine Society for Developmental and Behavioral Pediatrics (PSDBP) 6th Biennial Convention: Looking In and Linking Up REGISTRATION FORM September 9-10, 2011 EDSA Shangri La Hotel, Mandaluyong City Please check: MD SP OT PT SPeD Teacher Primary Hospital Affiliation/Therapy Center/School Teacher Parent Other: _________ LAST NAME Primary Practice Address FIRST NAME M.I. PRC NUMBER REGISTRATION FEE: Pre-Registration : Php 3000 On-Site Registration: Php 3500 Deadline for Pre-Registration: June 30, 2011 To Register, call 02-4343946 or email: devpedphil@gmail.com Manner of Payment: Cash/ Personal Check (for Pre-Registration Only) payable to PSDBP Or Deposit to PSDBP current account: BPI Family Bank, P. Tuazon, Cubao Branch (Account # 6015-0599557) For more information: Contact RJ Palor (PSDBP Secretary) +639228019057 or at 02-4343946 4th Floor Philippine Pediatric Society (PPS) Bldg, 52 Kalayaan Avenue, Barangay Malaya, Quezon City Nickname: ________ Specialty ___________ Subspecialty ______ Medical Society/Affiliation: ________________________________ Mailing Address: ________________________________________ ______________________________________________________ Mobile Number ___________________ Landline______________ Email Address: _________________________________________

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