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PhilippineAssociationofDiabetesEducatorsand

AssociationofDiabetesNurseEducatorsofthePhilippines
PLEASE

8thJointAnnualConventionDiabetesEducationLevelsUp PRINT

August27and28,2010CenturyParkHotel,ManilaCity

ConventionRegistrationForm(PDF)

CompleteName:______________________________________________________
Profession:___________________________________________________________
RETURN THIS FORM AND
PRCNo:______________________ExpiryDate:_____________________________ PAYMENT TO:
CurrentInstitutionalAffiliation(s):________________________________________
_____________________________________________________________________ PADE/ADNEPSECRETARIAT

CompleteMailingAddress:______________________________________________
94new571oldApitongStreet,
_____________________________________________________________________ MarikinaHeights,MarikinaCity
MobileNo:______________________Email:___________________
Howdidyoulearnaboutthisconvention?(Plscheckallthatapplies) Telefax:(02)9420313or
___Flier,___Poster,___Email,___ADNEPwebsite,___Text,___Colleague/Friend, (02)4708942or
(02)8690478
___Newspaper,___Other_____________________
Whatmotivatedyoutoattendthisconvention?(Plsrankaccordingtopriority1st,2nd,3rd,etc) Mobile: 0999.517.74.66/
___ConventionTopics,___ExpertiseofSpeakers,___Venue,___CPEUnits, 0922.887.51.64
___ReasonableRegistrationFee,___Other_________________
Website:www.adnep.org
PaymentDetails
Email:convention@adnep.org
Branchwhereyoumadethedeposit:_________________________

Dateoftransaction:_________________________
CANCELLATIONS

Timeoftransaction:_________________________ A 50% refund will be made for



registration cancellations received
before August 16, 2010. No
Amount:Php_________________________ refunds
can be made thereafter.

IMPORTANT
1.AlltransactionsreceivedafterAugust13,2010shallbeconsideredasONSITEregistration.
2.Detailsofbankpayment:
Bank:BPIFamilyBank AccountNo:5951065678
AccountName:PhilippineAssociationofDiabetesEducators
*Forcheckpayments,pleasemakecheckpayabletoPhilippineAssociationofDiabetesEducators.
3.Kindlycompletetheparticipantinformationsheetwithdetailsofpaymentandfaxitright
awaytoPADE/ADNEPSecretariat.
4.Youwillreceiveaconfirmatoryemailortextmessageoncethepaymenthasbeenvalidated.
5.Youmayalsoregisteronlinethroughourwebsite@www.adnep.org

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