PRIMA Membership Application Form
NAME (Last, First M.I.) *
Home/Mailing address *
Contact number *
E-mail address *
How did you know about PRIMA? Or who referred you? *
What is your concept of Integrative Medicine? *
Primary Clinic/Office and Address
Primary Clinic/Office Contact number
Medical/Dental School *
Degree(s) obtained *
Year graduated *
Post-Graduate Trainings (Program, Year, Institution)
PRC Reg Number *
PhilHealth Accreditation No.
Society Affiliations (Society/Group, Year Joined, Membership Status, Position [if any])
Hospital/Clinic Affiliations (other than the Primary)

The Membership Committee will review your application. You will then be advised on the next steps depending on the committee's evaluation. Should your application be approved, you will be instructed to pay the membership fee. Please do not make any payment before you are asked to do so.

Membership fees will be as follows:

Philippine based: PHP 1,500.00

Non-Philippine based: USD 50.00

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