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OPHTHALMIC SUPPORT STAFF REGISTRATION FORM

Registrant Information


Email Address*

Name* (lastname, firstname middleinitial suffix)

Street Address*

City

Province*

Zip Code*

Tel. No.(Country Code + Area Code) + Number*

Fax. No.(Country Code + Area Code) + Number


Registration Fee

COURSES CODE EARLY BIRD RATE
(Until October 13, 2017)
ONSITE RATE
(Starting October 14, 2017)
December 04, 2017 (Monday)
Basic Course* BC PhP 2, 000.00 PhP 2, 500.00
December 05, 2017 (Tuesday)
Error of Refraction/
Refractive Surgery Course**
ER/RC PhP 1, 750.00 PhP 2, 250.00
Oculoplasty Course/
Pediatric Ophthalmology and Strabismus Course**
OPL/PEDS PhP 1, 750.00 PhP 2, 250.00
Cataract Surgery Course** CS PhP 1, 750.00 PhP 2, 250.00
Glaucoma Course** GC PhP 1, 500.00 PhP 2, 000.00
Retina Course** RC PhP 2, 000.00 PhP 2, 500.00
Note:
*Fee is inclusive of handouts, materials and lunch.
**Fee in inclusive of handouts and materials ONLY
  • Fill-Out Form
  • Payment Verification
  • Payment Confirmation