* Refers to the required question

FIRST NAME: *

MIDDLE NAME:

LAST NAME: *

Full Name: (ex. Juan Dela Cruz, MD) * To appear in delegate ID

Profession:

Telephone Number:
if Not Applicable kindly put NA.

Cellphone Number: *

Email: *
Kindly double check the spelling of your email address. We will send a scanned copy of your Official Receipt here.

Hospital/Agency:

PRC ID Number:

PRC ID Expiry Date:

PRC ID Photo (Front): Upload 1 supported file: image. 10 GB max.

PRC ID Photo (Back): Upload 1 supported file: image. 10 GB max.

Please see Registration Fee Below

MODE OF PAYMENT *

You may pay your registration fee at the branches or online banking of the following banks:

AUTHORIZED BANKS:

Account Name: Diabetes Philippines, Inc.
METROBANK: 254-3-25402919-0
BDO (Universal Bank): 004-590297194
Metro Bank BDO

Kindly upload your proof of payment for us to process your Registration *.
Thank you! Upload 1 supported file: image. 10 GB max.

If you paid with discount, please upload your SENIOR or PWD ID here: Upload 1 supported file: image. 10 GB max.

You may also renew your MEMBERSHIP FEE here: (yr. 2024 & 2025)

Kindly upload your proof of payment for us to process your Membership. Thank you! Please disregard this part if dues have already been paid or will apply as a non-member in the DPAC registration. Thank you! Upload 1 supported file: image. 10 GB max.

Registration is Non-Refundable and Non-Transferable. For any concern and clarification you may contact us at the ff: Email: dpsecretariats@gmail.com Tel. No.: 8531-1278 | 8534-9559 Viber: 09287612091 Facebook Page: Diabetes Philippines or Diabetes Phil