Allied Health Professional Registration

          If your application will be approved by the board, you will be classified as an Associate Member and enjoy reduced conference rates.

First Name: First Name Required

Last Name: Last Name Required

Mobile number:* Mobile number is Required

PRC number (if applicable): PRC number (if applicable) is not valid

Medical field:* Medical field is Required

NurseOccupational TherapistPhysical TherapistMedical StudentOthers

Area of Practice or Institution affiliated with::* Area of Practice or Institution affiliated with: is Required

Email:* Invalid Email

Password:* Invalid Password

Password Confirmation:* Password Confirmation Doesn’t Match

 

No val Please fix the errors above