Early Bird Registration Form

Please select if you are registering as a *

Philippine Delegate/ Citizen International Delegate

Please visit our website at https://manilaidpacongress.org/registration-local-instructions/ to read the full registration procedure and list of Congress fees.

A picture or scan of your validated deposit slip is required to complete this registration.

Name as it will appear in your Certificate of Attendance *

First Name Middle Initial Last Name Suffix

Email Address *

Please make sure to provide a valid email address as your confirmation details will be sent here. This will be required to claim your registration kit.

Mailing Address *

Street Address
Street Address Line 2
City	State/Province
Zip Code	Country

Which Region of the Philippines do you belong to? *

Country of Residence *

Country of Residence

Visa Document Number (if applicable)

Please type in your Philippine Visa Document Number here.

Contact Number *

Area Code Phone Number

Contact Number *

Country Code Area Code Phone Number

Profession

Please indicate your profession.

PRC ID Number (if applicable)

Please indicate your PRC ID Number (if applicable)

IDPA Member ID Number (if applicable)

Please indicate your IDPA Member ID Number (if applicable)

Name of Organization

Name of Organization (if applicable)

Institution/ Hospital/ Center Affiliation

Name of Insitution/ Hospital/ Center (if applicable)

Please select a Pre-Congress Workshop you are most interested in. (and two alternates) *

Please select the Pre-Congress Workshop you are most interested in. *

Pre-Congress Workshop Preference

Please indicate the first of two alternates should your primary choice be unavailable *

Pre-Congress Workshop Alternate

Please indicate the second of two alternates should your primary choice be unavailable *

Pre-Congress Workshop Alternate

Meal Preference *

No Restrictions Vegetarian Halal

Would you be interested in attending the Mentoring Dinner? *

Yes No

Will you be submitting an abstract? *

Yes No

Do you have a promotional code?

Yes No

Please enter your promotional code here

Calculation

Registration Fee (via PayPal)

USD Your registration fee has been calculated according to your present Country of Residence, as well as its corresponding World Bank Economy Ranking (2018).

Please indicate the name to be placed on the Official Receipt

Validated Bank Deposit Slip Upload *

Browse Files

Please attach a jpeg or pdf file of your validated deposit slip.

UID Prefix