REGISTRATION FORM

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REGISTRATION FORM

PUBLIC HEALTH AWARENESS ON PHYSICAL FITNESS AND WELLNESS WEBINAR SERIES 2.0
May 19, 2023 | Friday | 1:30PM | Zoom

Topic 1:

Thriving, Not Just Surviving: Empowering Yourself Through Self-Care

Resource Speaker:
MARY ANN J. JINTALAN, RGC, LPT
Guidance Counselor, Sorsogon State University

Topic 2:

HIV-AIDS Awareness

Resource Speaker:
ROLANDO E. DEALCA, MD
City Health Officer, Sorsogon City

NOTE:

This form will serve as registration for Session 1 of the Public Health Awareness on Physical Fitness and Wellness Webinar Series 2.0 hosted by Sorsogon State University in partnership with Sorsogon City Health Office, Philippine Red Cross - Sorsogon Chapter, BU Institute of Physical Education, Sports and Recreation (IPSER).

Responses will treated with utmost confidentiality and will be securely stored to ensure protection and privacy of participants in compliance with the Data Privacy Act of 2012.

Email *

COMPLETE NAME (Last Name, First Name, Middle Initial) *

Please use sentence case. (example: Dela Cruz, Juan D.)

AGE *

GENDER *

Male

Female

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Trans

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"I prefer not to say"

Other:

CIVIL STATUS *

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Other:

HOME ADDRESS *

SCHOOL / INSTITUTION *

Please use sentence case. (example: Sorsogon State University)

POSITION / DESIGNATION *

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MOBILE NUMBER *

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