Association of Respiratory Care Practitioners, Phils., Inc.

An International Affiliate of the American Association for Respiratory Care (AARC)

and the International Council for Respiratory Care (ICRC)
A Partner Organization of the Canadian Society for Respiratory Therapist (CSRT)
Integrated Accredited Professional Organization for Respiratory Therapy,
Professional Regulation Commission
“Your Expert Partners in Respiratory Care”

CRN:2002262504
PCAN: AIPO-049

APPLICATION FORM Please tick on the box

1. NEW Membership

OR

2. RENEWAL of Membership

3. UPGRADE of Membership (Student to Professional)

4. COGS (Certificate of Good Standing) Certification Requirement for PRC Renewal / Data Flow

All Fields are Mandatory Information / Required (put NA if not applicable)

Given Name
Including
Surname Suffix (Jr. / Middle Name
Sr. / II, etc. if
applicable)
Professional Membership
Suffixes (if No. (if
applicable) Applicable)

Work Address All Fields are Mandatory Information / Required (put NA if not applicable)
Institution
Name /
Department
Hospital
Name
Barangay /
Street
Suburb

State / City / Postal

Country
Municipality code

Work phone Work Mobile

Work email

Home Address and/or Mailing Address if different from above

All Fields are Mandatory Information / Required (put NA if not applicable)
Barangay
Street
/ Suburb
State / City / Postal
Country
Municipality code
Personal
Home phone
Mobile
Personal email

ARCPP Membership Renewal.doc 1

 Association of Respiratory Care Practitioners, Phils., Inc.
An International Affiliate of the American Association for Respiratory Care (AARC)
and the International Council for Respiratory Care (ICRC)
A Partner Organization of the Canadian Society for Respiratory Therapist (CSRT)
Integrated Accredited Professional Organization for Respiratory Therapy,
Professional Regulation Commission
“Your Expert Partners in Respiratory Care”

CRN:2002262504
PCAN: AIPO-049

APPLICATION FORM (cont’d)

Please tick on the box

YES NO
5. Are you a current financial member of the ARCPP (updated membership for the past 2 years)
6. Do you wish to receive updates, promotional information and other related information related to
your membership and organizational affiliation?

7. Do you consent to the use of your information for legal and professional related activities

Appointed Representative (if applicable,

please include Authorization Letter and 1 Valid ID of
Representative)

Applicant’s / Member’s Signature

Date
(sign within/inside the box provided)

Copy of ID Picture of Representative

ARCPP Membership Renewal.doc

 Association of Respiratory Care Practitioners, Phils., Inc.
An International Affiliate of the American Association for Respiratory Care (AARC)
and the International Council for Respiratory Care (ICRC)
A Partner Organization of the Canadian Society for Respiratory Therapist (CSRT)
Integrated Accredited Professional Organization for Respiratory Therapy,
Professional Regulation Commission
“Your Expert Partners in Respiratory Care”

CRN:2002262504
PCAN: AIPO-049

APPLICATION FORM (cont’d)

FEES:

New Membership: ₱ 950.00 (good for two years)

Renewal of Membership:
Student Membership:
COGS Certification Fee:
Courier/Mailing Fee (if applicable):
₱ 350.00 (good for two years)
₱ 350.00 (good for two years)
₱ 300.00 (good for three years / one time use with PRC)
Luzon: minimum 117.00 (may change depending on distance/location)
Vis/Min: minimum 127.00 (may change depending on distance/location)
NCR: depends on GRAB rate

For Cash and/or Cheque Payments:

Cheque payment should be made payable to:

Association of Respiratory Care Practitioners, Phils. Inc. or simply, ARCPP, Inc.

For Bank / Online Payments:

Bank Name: Security Bank (Philippines)

Account Branch: St. Luke’s Medical Center, BGC, Taguig City
Account Name: Association of Respiratory Care Practitioners Phils., Inc,
Account Number: 0000 – 006424 – 900
Swift Code: SETCPHMM

Kindly email your application form together with your deposit slip at arcpp_phils@yahoo.com
Include a copy of your most recent (<6months old) 2x2 picture in JPEG Format.

Please direct all queries to:

ARCPP Secretariat
(Association Executive Services)
ARCPP Membership Email address:
arcpp_phils@yahoo.com

ARCPP Board Email address:

arcppofficial@gmail.com

Mobile Number:
(+63) 908 182 8792
(+63) 927 229 6236

ARCPP Membership Renewal.doc