Membership Application IV THERAPY REFRESHER COURSE APPLICATION FORM TERMS and CONDITIONS Requirements for the Registration and

Renewal of IVT Card 1.Original IVT Card 2.Original and photocopy of Certificates of Attendance of IVT Therapy Updates wh ich are equivalent to 24hrs/CEU as approved by ANSAP Institute 3.Two (2) recent 2x2 pictures with lightgreen background 4.Original and photocopy of PRC License 5.Payment of registration fee (P600.00/day) 6.Payment of IV Card renewal fee (P400.00) Requirements for Replacement of Lost IV Therapy Card 1.Original and Photocopy of Certificate of Attendance of the 3day Basic IV Thera py Training 2.Original and Photocopy of Certificate of Training from ANSAP 3.Notarized Affidavit of loss 4.Two (2) recent 2x2 pictures with lightgreen background 5.Processing fee (P400.00) Requirements for Change of Status 1.Photocopy of Marriage Certificate 2.Two (2) pcs 2x2 picture in lightgreen background 3.Photocopy of PRC license 4.Old IV Card 5.Replacement fee (P400.00)