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Short Course Registration
Prime Institute of Public Health
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Nature of the Activity for which the registration is ought
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Health Services and Systems Research-II
Diploma in Public Health Supply Chain, Quality and Management
Are you a
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General Practitioner
Resident / Trainee Medical Officer
Consultant
Postgraduate Student (Masters, Doctorate etc.)
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Medical/Dental Student
Non-medical graduate student
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Father/ Husband's Name
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CNIC Number (Use dashes e.g. 12345-1234567-1)
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PMDC Reg. Number (For Doctors only)
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Institutional Designation (if any)
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Affiliated Department and Institute/Hospital (if any)
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