CONFORME: By signing below, I acknowledge that the purpose of the activity is primarily for continuing medical / professional education.

I certify that there is no link between my attendance and the

recommendation of Nestle Infant Nutrition products covered by the scope of the WHO CODE and Executive Order 51 and its RIRR (Philippine Milk Code).

Attendance /Sponsorship Form

Platform: Type of Activity: Type of Expense:
Date: ________________________ Virtual Group Production Presentation Meals
Time: ________________________ Face to Face Brand initiated CME activity Perishable Tokens (culturally acceptable
occasions)
Venue: _______________________ Field Operations initiated CME activity Transportation Rental
Medical Detailing Activities Hotel accommodation
Others _____________________ Materials and services
PRINTED NAME SIGNATURE
Speaker/s:

TYPE OF HCP If with

PRINTED NAME INSTITUTION CPD points SIGNATURE / REMARKS

PEDIA OB General MIDWIF NURSE PRC #

Practitioner E

pg. 1
 TYPE OF HCP If with
PRINTED NAME INSTITUTION CPD points SIGNATURE / REMARKS

PEDIA OB General MIDWIF NURSE PRC #

Practitioner E

pg. 2