|
REGISTRATION
FORM
|
Member Non-Member
Dr.Prof. Mr. Ms./Mrs. |
|
Last Name
|
|
|
First Name
|
|
|
Middle
Name
|
|
|
Institution/Org.
|
|
|
Department
|
|
|
Address
|
|
|
City/Town
|
|
|
Postal
Code
|
|
|
Phone No.
|
|
|
Fax No.
|
|
|
Mobile
Phone No.
|
|
|
Email
|
|
|
Registration
Fees
|
- Member
(who attended three consecutive PNIC conferences) : Free
- Donor
Member: Php 880.00 on or before
Oct. 30,2010
- Pre-Registration:
- On-Site-registration:
Php 1,000.00
|
|
Payment
for Pre-Registration
|
- Bank
transfer (Please fax the photocopy of the bank transaction slip to
567-2397)
- Savings
account: 200-601128-7 PFV
(PNB-PGH Taft Branch)
3283-5189-21
(BPI-Ermita Branch)
- Check
(Please make check payable to Philippine Foundation for Vaccination)
|
|
Send all
queries/concerns
re: registration by fax/e-mail to:
|
The
Secretariat
Philippine Foundation for Vaccination (PFV)
c/o Section of Infectious & Tropical Diseases (INTROP)
Department of Pediatrics, UP-PGH
Tel: 632 526-9167
Fax: 632 567-2397
e-mail: pfvinc@yahoo.com , admin@philvaccine.org
Website: www.philvaccine.org
|
|
|
