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Registration Form

 Member  Non-Member
Name: ____________________________________________________________________
Surname First Name M.I.
Address: __________________________________________________________________
Contact Number: ________________________________
Email Address: ___________________________________
 Employed: Hospital / Office: _____________________________________________
 Not Employed
PRC No.: ______________________________ Valid Until: _________________________

Is this your first time to attend CCNAPI updates/workshop? Yes No

How did you learn about CCNAPI and its activities?
 CCNAPI Bulletin Board  Colleagues
 Others: _________________  Website


1. Effective June 3, 2010, registration fees are inclusive of:
 Handouts  Appropriate
 Credit Units  Free flowing coffee
2. Participants are encouraged to register ahead of time (pre-registration).
3. Appropriate attire should be worn for the update/workshop.
4. Be on time. Punctuality if a virtue of a professional.
5. Mobile phones should be on silent mode at all times inside the training room.
6. Interaction during the session is highly encouraged.
7. Softcopy of the handouts are not provided.
8. Certificate of Participation will be earned at the end of the seminar, provided that all participants have
complete attendance. No latecomers, no absentees.
9. Once enrolled, the registration fee is NON-TRANSFERABLE, NO RESCHEDULING ALLOWED and REFUND
a) Refund request made 2 WEEKS BEFORE THE PROGRAM, shall be refunded, but subject to deduction of P250.00 from
the total registration payment for Administrative Services;
b) Refund request made 1 WEEK BEFORE THE PROGRAM, shall be refunded, but subject to deduction of 50% from the
total registration payment for Administrative Services and reservation of slots; and
c) Refund request made ON THE DAY OF THE PROGRAM OR ONWARDS, NO REFUND shall be given.
I understand the REFUND POLICY of the Critical Care Nurses Association of the Philippines, Inc, and
that I abide by this agreement.

CONFORME: ________________________

For CCNAPI Staff Use Only:

Date of Pre-registration: _______________
Amount paid: ______________ OR No.: ________________
Topic/s enrolled: _________________
Encoded by: _____________________

jajg/micr 060310

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