ONLINE REGISTRATION
THIS PART IS REQUIRED!

*
*
*
*
*
*
*
*
*
* required fields

(YES if checked, NO if unchecked)
If checked, the corresponding registration fee for a registered accompanying person will be added automatically in the Registration Fee section of this form (below).

THIS PART IS REQUIRED!

The registration fee entitles delegates access to all scientific sessions, commercial exhibitions, welcome reception and fellowship night and receipt of book of abstracts, certificate of attendance and other conference materials.

FULL CONFERENCE REGISTRATION FEES
Category Regular/Onsite
Feb 15, 2013 and Onwards
(In US Dollars)
ARPaC Delegates (from ASEAN)  $ 400.00
ARPaC Delegates (Non ASEAN)  $ 450.00
ARPaC Trainees (Residents)  $ 350.00
ARPaC Medical Students  $ 250.00

Accompanying person/s ($ 250.00 per person -- from Section A above)  

The welcome reception is included in the full registration fees for ARPaC/PAFP delegates (including registered accompanying persons).

For catering purposes, indicate your attendance by ticking the boxes. If you would like to purchase tickets for your partners and guests, please indicate the number required.

There is sports activity which is free for delegates but not for accompanying persons. Cost per additional ticket is US$ 20.00.


Event Attendance Cost per ticket No. of additional tickets Total cost
Thursday - 07 March 2012
Fellowship and Socials *
Yes $50.00 per person $
Friday - 08 March 2012
Sports activity *
Yes $20.00 per person $
$
*   (Free to registrants)
** (Free to registrants and registered accompanying person/s)

Input name(s) of additional attendee(s) in the box below:
   You can input the names continuously separated by a comma or you can input them one name per line. You can use the ENTER key to move down to a new line.
THIS PART IS REQUIRED!

I do NOT require the conference managers to initiate hotel reservation/s on my behalf.

I require the conference managers to initiate hotel reservation/s on my behalf.

Please advice if you or your guest(s) have any special requirements (eg. dietary, health, physical disabilities), every attempt will be made to meet these requirements, however, this may not be possible in every case.


Input special requirements in the box below:

The PAFP expects a large number of family doctors/GPs to attend from developing nations in the Asia Pacific region and beyond. Some will be doctors who will have difficulty in affording the costs associated with attending this conference.

We invite you to help us support the delegates from developing nations to attend the conference through the bursaries fund. It's a truly great opportunity to extend the hand of friendship. Donors to the bursaries shall be recognized in the souvenir program.

I would like to support the delegates from developing nations attend the conference:

US$ 50 US$ 100 US$ 150 US$ 200
I do NOT wish to have my name listed as a donor in the conference proceedings.

A book containing all the presentation abstracts featured in the conference program will be issued to all delegates upon registration at the conference. In the interest of the environment and due to the anticipated size of the book, the conference organizers decided to have the book in PDF format on a Compact Disc (CD). PDF is a computer file that can be read by Adobe Acrobat Reader, a free software installed in almost all computers.

By default all registrants will be given a book of abstracts. If you prefer to not receive a copy, please click on the checkbox below:

I would NOT like to receive a copy of the abstracts book (I am happy to view the abstracts on the website)

Please note that a program book will be given to all delegates upon registration at the conference.

The Philippine Academy of Family Physicians (PAFP) will collect and store information you provide in this registration form for the purposes of enabling us to register your attendance at the conference, to assist with administrative and planning purposes and for future planning and development of PAFP conferences, and other events, to facilitate your requirements in relation to the conference, and to allow the compilation and analysis of statistics.

The information that you provide in the registration form and information provided at any other time during the conference, including without limitation, any feedback obtained during the conference, will be used by the PAFP to offer, provide and continue to improve its conferences and other services.

The PAFP may disclose some information that is collected in the registration form such as your name, organisation and its location, and your email address for marketing or networking purposes to other conference delegates, sponsors or exhibitors unless indicated below.

The PAFP will not otherwise, without your consent, use or disclose your personal information for any purpose unless it would reasonably be expected that such purpose is related to the offer, provision and improvement of the ARPaC 2013 Conference and the PAFP or where such purpose is permitted or required by law.



I do NOT wish my contact details to be disclosed to any sponsors, exhibitors or other delegates.

PAUSE!

Please take time to examine the amounts shown on the table. The subtotals shown are the effect or sum of the choices you made in their respective section boxes above. You can go back to a section and make a correction by clicking or unclicking radio buttons or check boxes and/or changing the number/s you entered in data input boxes.

B. Registration Fee/s $
C. Social Program $
F. Bursaries $


TOTAL FEES : $ This is the amount that you will either pay through Bank Transfer or will be charged to your credit card / Paypal.
THIS PART IS REQUIRED!

To ensure that you have seen and noted the Total Fees (amount to be paid) shown in Section I, you need to enter the same amount in the box provided on the right. If the amounts match, this section will be opened and you can proceed to choose your method of payment.

Please press the TAB Key or click anywhere on the screen outside of the input box after inputting the amount.
 
THIS PART IS REQUIRED!

Please take a little time to answer the simple math question below to ensure that this form is not being submitted by a computer.

Thank you.

CAPTCHA image
Enter Answer:
  

Cancellation of conference registration received in writing at the conference office by January 21, 2013 will be accepted and all registration fees refunded less an administration fee of US$100. Cancellations received after this date cannot be accepted and will not be refunded.

Transfer of registration to another person is allowed provided that the communication of intent to transfer registration together with the full name and details of the replacement must be received in writing by the conference organizers on or before January 21, 2013.

No refunds will be made for nonattendance.



 
I have read and agree to all terms and conditions outlined in this registration form.
  
by: Nieve Terra ***   ntolabing@gmail.com ***   +639175994970 ***   Sonar Theme