Course will be held @ the college of Anaesthesiologists of Sri Lanka –Colombo 8 ( Opposite Lady Ridgeway Hospital – Maradana road entrance)
ILS -Course Fee 2000 Rs
Email address *
1.Select preferred ILS course date *
Target group- Nurses, OPD & Community based doctors,Preinterns
2. Full Name *
As per your ID card/Passport/Birth Certificate
Your answer
3. Surname followed by initials *
e.g; Premaratne E.M.J
Your answer
4. How your name should appear on the certificate *
Please double check the Name.
Your answer
5. First name *
For the name tag
Your answer
6. Mobile number *
Your answer
7. Designation *
If answer is other @Please mention in your comments
8. Specialty / Area of practice *
9. If your answer is "Other" to above question, state the specialty or place of work
Your answer
10. Hospital/ Institution *
e.g , P.G.H Badulla , D.G.H. Gampaha / B.H. Panadura / NHSL / Locum, None
Your answer
11. Date of Birth *
12. NTS/University *
e.g- Colombo University , Kandana NTS or other
Your answer
13. If your answer is "Other for above question, state the University
Your answer
14. Post graduate qualification if any
e.g- Diploma/MSC - Nutrition, DFM,
Your answer
15. SLMC Registration number *
If not registered yet , indicate " No"
Your answer
16. Have you completed any of following life support courses with in last 2 years ? *
17. Meal preference *
18. Any special requests/comments
Different course date, CPR courses done, Special assitance
Your answer
19. I hereby agree that the above information are true and correct according to my knowledge, and will check my email box and respond accordingly *
A copy of your responses will be emailed to the address you provided.
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