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EMPLOYEE: Prepare one copy of form and secure the necessary approvals. Send form to HRD for
registration and payment. Registration for seminars, conventions, business meetings/trips,
etc. abroad may be handled directly by the department concerned. Form will be returned by
HRD to employee and should be kept by employee until after completion of the course.
Shaded areas for HRD use only.
ID NO. ATTENDEE’S NAME DATE ACCOMPLISHED CODE
1596 Clemena, Teotimo Ciriaco Jr. B. November 6, 2008
JOB TITLE TRAINING/MEETING COURSE TITLE
Staff Industrial Nurse Emergecy Room (ER) Exposure Training
SECTION TRAINING ORGANIZATION/SCHOOL
Health & Medical Services Bicol Regional Teaching & Training Hospital
DEPARTMENT PLACE OF TRAINING/MEETING
OE/HESS BRTTH, Legazpi City
LOCATION DATE(S) OF TRAINING/MEETING NO. OF DAYS/HOURS
Makati Mak-Ban Tiwi From November 10 Days 5
To November 14 Hours 40
WAY IN WHICH TRAINING/MEETING WILL BENEFIT COMPANY MODE OF EXPENDITURE
Per Diem Actual/Receipted
The Emergency Room Exposure Training will further enhance the skills, COST OF REGISTRATION/TUITION
knowledge and attitude of the participant in dealing with emergency PhP USD 1,500.00
situation especially during field operations. Training and continuous skills COST OF TRAVEL
development will be very beneficial during medical and health responses PhP USD 500.00
for it is an integral component of medical emergency responses. COST OF BOARD & LODGING
PhP USD 1,000.00
TOTAL COST
PhP USD 3,000.00
COST CENTER
HRDForm: MEA