PSUOG Pearl 2023 | 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 *

*** DEC 1(Day 2) - PLENARY SESSION ONLY ***

CATEGORY*

REGISTRATION AMOUNT + MEMBERSHIP DUES

I will attend the FELLOWSHIP NIGHT - December 1, 2023 | 7:00PM to 11:00PM

*Required Field

NOTE:
1. After submission, Please wait for the successful confirmation message before closing this page.
2. If you do not receive the confirmation message within a few minutes of signing up, please check your SPAM folder just in case the confirmation regemail got delivered there instead of your INBOX. If so, select the confirmation message and click Not Spam, which will allow future messages to get through.

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