Membership Form

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Preferred Mailing Address





Select Any TWO council Membership that you want to get actively involved with *








Address

________________________________

>Registration fee discount in DP scientific programs.

>Free two (2) Diabetes Watch Magazines per year.

NOTE: * MUST BE FILLED UP

Membership renewal should be done on or before November 30 of the current year.


CASH
Bank Transfer

You may pay your membership fees at the branches of the following banks:


Methrobank: S/A No. 254-3-25402919-0
PNB(Formerly) Allied Bank: S/A No. 3240020287

Check No. ________________ Issuing Bank __________________

Note:

  • Please return accomplished form and payment to:

    Diabetes Philippines Secretarist,
    661 BONI AVENUE corner LIGAYA STREET MANDALUYONG CITY 1501
    TEL.: 8531-1278 , 8534-9559
    FAX: 8531-1278
    Email:diabetesphilippines@pldtdsl.net
    Webiste: www.diabetesphilippines.org

  • if payment was made thru bank please attach duplicate copy of your deposit slip with your application form
  • Only application form accompanied by payments will be processed