2019 PSHOA Regional Seminar Online Registration & Payment Confirmation
Event Date: August 24, 2019 | Saturday
Event Address: Venus Parkview Hotel, Kisad Rd. Baguio City
Contact us at pshoa1980@yahoo.com or pshoa.reg@gmail.com

Download letter of invitation at https://drive.google.com/open?id=1v0wo8CZ03zDJgscUYTje_Np9r9e3QS9B

Email address *
Last Name, First Name, Middle Initial (e.g. DELA CRUZ, JUAN S.) *
Your answer
Profession *
School Affiliation *
Your answer
School Address *
Your answer
School Clinic Landline / Mobile No. *
Your answer
Personal Contact Number *
Your answer
PRC License Card No. (write 00000 if not applicable) *
Your answer
Expiry Date *
MM
/
DD
/
YYYY
TIN (e.g. 123-456-789-000) *
Your answer
Is this your FIRST TIME to attend a PSHOA Convention? *
I understand that I have to pay P1,200 as ONLINE registration fee and payment must be made thru bank deposit (NOTE: P1,500 for walk-in/on-site registration) *
Before proceeding, make sure that payment has been made through bank deposit
Payment Confirmation (via Bank Deposit)
Date deposited *
MM
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DD
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YYYY
Time deposited *
Time
:
Transaction Code *
Your answer
Branch/Location *
Your answer
I verify the authenticity of the information shared above and entrust PSHOA, Inc. for the safety and privacy of my personal information. I also ensure the correctness and validity of my email address and other information for verification purposes. *
Required
A copy of your responses will be emailed to the address you provided.
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