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 )
Email address *
1.Select preferred ALS course date *
Target group- Those who were selected as Instructor Potential candidates - From ERC Provider course
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 *
Certificate will be system generated as your name appears in ERC Guest account .
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 *
MM
/
DD
/
YYYY
12. University *
e.g- Colombo University
13. If your answer is " Overseas or Other" for above question, state the University
Your answer
14. Post graduate qualification if any
15. SLMC Registration number *
If not registered yet , indicate " No"
Your answer
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
19. Any other remarks /comments/request in support of your application *
Your answer
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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