20th ASEAN FEDERATION OF ENDOCRINE SOCIETIES (AFES) CONGRESS

Theme: LINKED: Leading Innovation, Networking and Knowledge in Endocrinology and Diabetes
November 21-23, 2019
Philippine International Convention Center, Manila, Philippines
Hosted by: The Philippine Society of Endocrinology, Diabetes and Metabolism, Inc. (PSEDM)

REGISTRATION FORM FOR PROMOTIONAL BUNDLE

FOR 1 TRAINOR AND 2 TRAINEES
Date Registered: __________________

TRAINOR:
Surname First Name Middle Name

Title: Specialty: PRC License Number:

Training Institution/ Hospital:

Contact Number (Landline): Mobile Number: Email Address:

TRAINEE 1:
Surname First Name Middle Name

Cuerdo Anna Rossa Magda Santero

Title: PRC License Number: Email Address:
MD 132338 annacuerdo30@gmail.com
Training Institutions/ Hospital:

Perpetual hospital medical center - las pinas

TRAINEE 2:
Surname First Name Middle Name

Title: PRC License Number: Email Address:

Training Institutions/ Hospital:

REGISTRATION FEE:
Local Delegates Pre-Registration On Site
(Sept. 16– Oct. 15, 2019) (Oct. 16 – Nov. 23, 2019)
Physicians 5,000.00 7,000.00
Trainee (Fellow and Residents)/
4,000.00 5,000.00
Allied Health Professionals/Nurses
Gala Dinner/Fellowship Night 2,000.00
Accompanying Person 5,000.00

Option 1: Online Payment – www.afes2019.org

Option 2: Cash Payment
AFES Secretariat
Unit 2005-2006, 20/F, Medical Plaza Ortigas, 25 San Miguel Avenue, Ortigas Center,
Pasig City, Philippines, 1600 Tel No: (632) 633-6420 Fax No: (632) 637-3162
Option 3: Bank Transfer
Bank Name: Bank of the Philippine Islands (BPI)
Account Name: The Philippine Society of Endocrinology, Diabetes and
Metabolism, Inc.
S/A NO.: 3993-0403-54
 If payment was made thru bank please attach duplicate copy of your deposit slip
together with your registration form and email to sec@afes2019.org
 Only registration form accompanied by payment will be processed