Register and Join!

Kindly accomplish and completely fill up our pre-registration form. Do not type in ALL CAPS.
NOTE: Fill-up the required fields marked with (*). Incomplete details will make your registration invalid.

First Name *
Middle Initial
Last Name *
Address *
Telephone/Fax
Cellphone/Mobile *
E-mail Address * Example: nurse@yahoo.com
Age	16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 and above
School/Organization
Nursing is my..	1st course 2nd course
I am employed as	Nurse Nursing Aid Caregiver Registered Nurse Unlicensed Nurse Undergraduate Others
What test/s did you already availed and passed?	Local Board Exam IELTS NCLEX TOEFL Others
How did you know the event?	Please Select Advertisements Family/Relatives Friends Flyers Newspaper Internet Posters Radio Others
Would you like to be notified on future nursing conferences?	Yes No
I will join the event's.. *	Conference Expo Both
Days Attending *	Friday (Sept 19) Saturday (Sept 20) Sunday (Sept 21)
Additional Concerns/Message
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