ICP Membership Registration Form

1. Prepare for the following files to be uploaded in the registration form:

- Scanned copy, photograph, or screenshot of your payment transaction as proof of payment for your ICP membership fee (REQUIRED)
- Scanned copy or photograph of your PRC Chemist or Chemical Technician license (REQUIRED)
  Note: Successful examinees of the 2021 Chemist/Chemical Technician Licensure Examination are EXEMPTED from this requirement.
- Your ID picture for the ICP membership card (white background in a 1:1 aspect ratio) (REQUIRED)
2. Make sure to review your entry before submitting. The information printed on your membership card will appear as entered in this form.

3. A confirmation message will be sent to your e-mail shortly after submitting your form; check your e-mail immediately. In rare instances, the confirmation message may be placed in your spam folder so make sure to check this as well.

For GMail users: check your inbox’s Promotions folder as well. The confirmation message will be sent as long as you have entered the correct e-mail address.

4. Expect to receive an e-mail within two (2) days from an ICP staff if you have a discrepancy in your submission which may forfeit your remitted payment and membership application.

Fields with an asterisk (*) are required. Maximum size of each file attachment: 1 MB.

APPLICANT DETAILS

Applying for * :

Membership Type * :

Intended Chapter / Cluster * :

Your Name * :

Date of Birth * :
Day:Month:Year:Current Age Bracket * :

Place of Birth * :

Complete Home Address in the Philippines * :
Please refrain from using acronyms and/or abbreviations.

Cellphone Number * :
The ICP may contact you through this number for any immediate concern regarding your membership application.

Enter Your E-Mail * : 🡸 Check the spelling!
Kindly ensure that your email is correctly spelled as the membership confirmation message will be sent here.
The ICP may also contact you through this e-mail address in case your membership registration has any discrepancy.
Confirm Your E-Mail * :

Type of PRC Professional License * :
For recent board-passers yet to acquire their PRC licenses, indicate the licensure examination you passed.

PRC Professional License No. * :
For recent board-passers yet to acquire their PRC licenses, write N/A.

Upload your PRC license here:
PDF / JPG / PNG file only. Maximum size: 1 MB.

Date of Issue:
Day: Month: Year:
Issuance date of your PRC license as indicated.

Date of Expiry:
Day: Month: Year:
Expiration date of your PRC license as indicated.

Educational Background *
Please follow the format: Degree Title (Year Awarded), Name of Institution
Example: BS-Chemistry (2011), University of the Philippines Diliman

EMPLOYMENT DETAILS
Please refrain from using acronyms and/or abbreviations.

Nature of your employment: *

Name of Company / Affiliation *
Write N/A if not applicable.

Complete Address of Company / Affiliation *
Write N/A if not applicable.

Current Position in Your Company / Affiliation

PAYMENT DETAILS

Payment Method Used * :

Upload your proof of payment here * :
JPG / PDF / PNG file only. Maximum size: 1 MB.

Amount Paid (PHP) * :
Amount as reflected on the proof of payment.

Payment transaction reference number * :

Payment remitted on * :
Day:Month:Year:
Date of transaction as reflected on the proof of payment.

MEMBERSHIP CARD DETAILS

Upload your ID picture here * :
JPG file only. Maximum size: 1 MB. Maximum dimension: 800 x 800 pixels.

Mode of acquiring ICP membership card * :
Note: for delivery, the fee (PHP 200) must already be included in your payment.

Check all to proceed submission:

I have included the delivery fee of PHP 200 in my payment.

I forfeit any excess remitted payment.

All of the information written above are true and correct.

I agree to the ICP's policy on data privacy.

NOTE: You may register only once. In case of multiple submissions,
your first entry will be the one deemed valid so make sure to
check your entry before clicking the SUBMIT button below.

Kindly wait for a status prompt to appear below after clicking the SUBMIT button.
(Or check your email five minutes after clicking the same button.)

STEP 2: Accomplish the Membership Registration Form Below