ERC- GENERIC INSTRUCTOR (GIC) COURSE 2018- Sri Lanka
Full time Two day course,( 07:30-17:30) . Course will be held " CLINMARC-NHSL-Colombo -Sri Lanka)
Course fee- 25000 Rs. ERC IP s can apply for this course ( Preference will be given to those who have shown interest in teaching )
1.Select preferred ALS course date
Target group- Those who were selected as Instructor Potential candidates - From ERC Provider course
27-28 Nov 2018- Colombo-Waiting list
29- 30 Nov 2018- Colombo-waiting list
2. Full Name
As per your ID card/Passport/Birth Certificate
3. Surname followed by initials
e.g; Premaratne E.M.J
4. How your name should appear on the certificate
Certificate will be system generated as your name appears in ERC Guest account .
5. First name
For the name tag
6. Mobile number
If answer is other - Please mention in your comments
8. Specialty / Area of practice
Gyn & Obs
9. If your answer is "Other" to above question, state the specialty or place of work
10. Hospital/ Institution
e.g , P.G.H Badulla , D.G.H. Gampaha / B.H. Panadura / NHSL / Locum, None
11. Date of Birth
e.g- Colombo University
13. If your answer is " Overseas or Other" for above question, state the University
14. Post graduate qualification if any
MD- Gyn & Obs
15. SLMC Registration number
If not registered yet , indicate " No"
16. Have you selected as an IP at the ERC ALS /ILS courses within last 2 years ?
17. Meal preference
18. How many courses ( ALS/ILS/CPR Preintern) you have instructed within last 2 years
Different course date, CPR courses done, Special assitance
Yes , but can't remember how many course
19. Any other remarks /comments/request in support of your application
20. 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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