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

Online Registration Form

I have read and understood the Registration Procedures of the IMPETUS 2019 PPTA National Convention.

*BEFORE YOU PROCEED, CONFIRM THAT YOU HAVE READ AND UNDERSTOOD THE REGISTRATION PROCEDURES

*Required fields

Upload the following documents

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Registration Category*

For 1-day registrants, indicate on which day you will attend:

Proof of PPTA Membership*

(Upload image file: .JPG, .PNG, etc.)

Select File
Max File Size 15MB

For non-PPTA, upload an official ID.

For students, upload your school ID.

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Registration Type*

Deposit or Transaction receipt*

(Upload image file: .JPG, .PNG, etc.)

Select File
Max File Size 15MB

Date of Payment*

Personal information

PRC License number*

For those who are not PRC-registered or are undergraduate students, enter N/A.

NOTE: The name that you will provide here shall appear exactly on your Certificate of Attendance.

Last Name*

Given Name(s)*

Middle Initial

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Sex*

Email address*

Contact number*

Name of institution of current affiliation*

Official receipt information

Do you want to receive an official receipt of payment for this convention?*

Name to appear on receipt

Amount paid

Wait around 5 seconds until you are redirected to an acknowledgement page.

Speed of submission depends on the speed of your internet connection and size of the files that you are uploading.