PSUOG Rise 2024 | Registration Form

REGISTRATION FORM

LAST NAME*

FIRST NAME*

MIDDLE NAME

PRINT NAME AS TO APPEAR ON CERTIFICATE*

EMAIL ADDRESS*

MOBILE NUMBER *

PRC NUMBER*

PRC EXPIRY DATE*

PMA NUMBER *

CATEGORY*

REGISTRATION AMOUNT + DUES

Nov 30, 2024: Night with the Experts (No seats available)

December 1, 2024 (Whole day Scientific Program)

I will attend the FELLOWSHIP NIGHT - December 1, 2024 | 7:00PM to 11:00PM

*Required Field

NOTE:
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By registering in this post graduate course, I hereby confirm that I authorize PHILIPPINE SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY and its affiliates to collect, process, store the information provided in this registration form for legitimate business purposes, as proof of my attendance and participation in this event which may be published accordingly and for any follow up business activities related to my participation in this event. I give my consent for my NAME and EMAIL ADDRESS to be shared with the industry partners only for attendance purposes in the industry sessions.

For assistance regarding your registration, please contact technical support at
Text/Call: +639384414225 | Viber: +639384414225 | email: smileboxph.events@gmail.com