DEMO FORM

Step 1: Attendee Information

Full Name

Email Address

Mobile Number

Organization / Hospital / Company

Step 2: Registration Type

Choose your registration type

—Please choose an option—Early Bird – PHP 2,500Regular – PHP 3,000Student – PHP 1,500Speaker / VIP – PHP 0

PRC License No. (if applicable)

Step 3: Optional Add-ons

Select add-ons (if needed)

Accommodation ArrangementPickup / Shuttle

Accommodation Details (fill out only if you selected Accommodation)

Hotel Preference

Check-in Date

Check-out Date

Room Type Preference

—Please choose an option—SingleTwin SharingDoubleFamily / Suite

Number of Guests

Shuttle / Pickup Details (fill out only if you selected Pickup / Shuttle)

Pickup Point

Pickup Date

Pickup Time

Flight No. (if airport pickup)

Drop-off Destination

Step 4: Payment (Offline)

Payment Method (choose one)

Bank TransferGCashMayaQRPh

Amount Paid (PHP) — if already paid

Payment Reference No. (optional but helpful)

Upload Proof of Payment (JPG/PNG/PDF, max 5MB)

Payment Instructions

After submitting, you will receive a Pending Registration email.

Your registration will be confirmed once payment is verified.

IMPORTANT: Use your Full Name as payment reference if possible.

Notes / Special Requests

I confirm that the information provided is correct.

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