eS Philippine Nursing Research Society Inc Membership Application Form To apply for PNRS membership, please print the Application Form, complete it (including signature) and return it to the Secretary by fax (fax-number: +63 83 554 1905). Awelcome letter and invoice will be sent. ‘The annual fee for members follows the calendar year. Only one person should apply per form. The membership automatically continues for the next calendar year, unless written notice is given to the Secretary of the Board (secretariat@philnurses.net), at least one month proceeding to the next calendar year. Membership Category CJ Student Member ~ BSN students (Php 100.00/year) C1 Basic Member — New RNs(Php 300.00/year) Cl Regular Member — Post-graduate with degree research works (Php 500.00/year) Advanced Member ~ Experts (research mentors, published works in journals, research project management (Php 500.00/year) Family Name First name Gender O Male CO Female Title(s) | Dr. Prof. Mr. Ms. Organisation Position Mailing Address Postal Code City Phone Fax E-mail Website pasion ares of Cl dinical [J teaching © publichealth ["]Other. Thave read the General Information and agree to the terms and conditions. Date Signature For membership payments, kindly deposit to Philippine Nursing Research Society Inc., RCBC Savings Bank (Remedios Branch) RCBC Savings Bank (Remedios Branch) is: 00001-052-10819-2. Email or text deposit slip details to research@philnurses.net or 09178113861 (Dr. Anonuevo)