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					                                          Philippine Association of Diabetes Educators and 
                                          Association of Diabetes Nurse Educators of the Philippines 
                                                                                                                             PLEASE
           
                                          9th Joint Annual Convention “Listen. Empower. Transform”                           PRINT 
                                                                     
                                          August 26 and 27, 2011 •   Century Park Hotel, Manila City 

                                                Convention Registration Form (PDF) 


Complete Name: ______________________________________________________ 
Profession: ___________________________________________________________    
                                                                                                            RETURN THIS FORM AND
PRC No: ______________________ Expiry Date: _____________________________                                              PAYMENT TO:
Current Institutional Affiliation(s): ________________________________________ 
_____________________________________________________________________  PADE/ADNEP SECRETARIAT 
                                                                                                           
Complete Mailing Address: ______________________________________________ 
                                                                                                          ISDFI Building 
_____________________________________________________________________                                     94 (new) 571( old) Apitong Street, 
Mobile No: ______________________ Email: ___________________                                              Marikina Heights, Marikina City 
How did you learn about this convention? (Pls check all that applies)                        
___ Flier, ___ Poster, ___ Email, ___ ADNEP website, ___ Text, ___Colleague/Friend,        Telefax: (02) 941‐98‐56 or  
                                                                                                                          (02)  584‐6992   
___ Newspaper, ___ Other _____________________                                                                             
What motivated you to attend this convention? (Pls rank according to priority – 1st, 2nd, 3rd, etc…)      Mobile: 0999.517.74.66/
___ Convention Topics, ___ Expertise of Speakers, ___ Venue, ___ CPE Units,                                             0922.887.51.64
___ Reasonable Registration Fee,  ___ Other _________________                                             Website: www.adnep.org 
Payment Details                                                                                            
                                                                                                          Email: convention@adnep.org 
Branch where you made the deposit: _________________________ 
                                                                                                           
Date  of transaction: _________________________                                                          
                                                                                                       CANCELLATIONS
Time of transaction: _________________________                                                         A 50% refund will be made for
                                                                                                         
                                                                                                        registration cancellations received
                                                                                                        before August 1, 2011. No refunds
Amount: Php _________________________                                                                    
                                                                                                        can be made thereafter.
 
                                                                                                         

                  IMPORTANT  
                  1. All transactions received after July 15, 2011 shall be considered as ON‐SITE registration. 
                  2. Details of bank payment:  
                                   Account Name: Philippine Association of Diabetes Educators, Inc 
                                   Account No: 001583‐0509‐37 
                                   Bank: BPI        Branch: Morayta FEU 
          *For check payments, please make check payable to Philippine Association of Diabetes Educators, Inc. 
                  3. Kindly complete the participant information sheet with details of payment and fax it right 
                  away to PADE/ADNEP Secretariat.  
                  4. You will receive a confirmatory email or text message once the payment has been validated. 
                  5. You may also register online through our website @ www.adnep.org 

				
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