Membership Form (Life/Contributing) Privileges of MembersBecome our partner in the promotion of mental health.Be invited and avail of discounts to educational activities like seminars, workshops, training, lecture-fora, etc.Access to reprints of papers/article on mental health including research studies conducted by the Association.Involvement in mental health committees on educational and clinical services.Maybe invited to e nominated and elected as one of the PMHA CCI’s Board of Management. Type of Membership (required) Life (Individual) Php3,000.00 (Lifetime)Contributing (Professional) Php300.00 (1 Year) Last Name (required) First Name (required) Midlle Name (required) Gender MaleFemale Citizenship House No., Street, Barangay, Municipality Region (required) —Please choose an option—CARREGION 1REGION 2 Province —Please choose an option—AbraApayaoBenguetIfugaoKalingaMt. Province Province —Please choose an option—Ilocos NorteIlocos SurLa Union Province —Please choose an option—BatanesCagayanIsabelaNueva VizcayaQuirino Office/Workplace Address Residence Phone No. Office/Workplace Phone No. Email Address (required) Mobile No. TIN (for Life membership registrants only)