Room 107, UHOP Office, PMA Building, PMA Complex,

North Avenue, Quezon City, Metro Manila, Philippines

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©2019 by Philippine Physical Therapy Association

PPTA Membership Application Form

*Required fields

Documents needed before application

Scanned copy of updated PRC ID*

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PRC License number*

Bank receipt with name & signature of applicant*

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Expiry date of PRC license*

Personal information

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Present address*

Permanent address

Mailing address*

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Sex*

Email address*

Date of birth*

Mobile number*

Landline number

Educational background

College/university you graduated from*

Title of undergraduate thesis 

Date of graduation*

Master's/Doctorate degree(s)

Indicate year of graduation or if on-going

Title(s) of other unpublished or published work(s)

Licensure examination

PT Licensure exam passed*

Other professional exam(s) passed

Current practice

Present type of practice*

Name of institution of current affiliation*

Address & contact number(s) of Institution of present affiliation*

Position*

Work experience (excluding present affiliation)

Name of Insitution, Position, Inclusive Dates of Employment

Specialization

Professional area(s) of interest or specialization*

PPTA Special interest group (SIG) you'd like to join*

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PPTA Working committee(s) you’d like to contribute to*

Would you like to be a member of a chapter?*

PPTA chapter is a subdivision of the association membership demarcated by political geography comprised of the provinces of the country. This is supposed to empower members in particular locality and will help strengthen the organization as a whole.

If YES, please indicate your province as place of work

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