2018 Local APLS Registration form
Surname (De Fernando ) *
Your answer
Name on the tag ( Kamal) *
Your answer
Name how it should appear in the certificate *
Your answer
Mobile number(without initial zero) (eg-778899220) *
Your answer
Your e mail (please send a test mail to cpd.slcp@gmail.com) *
Your answer
NIC or Passport Number *
Your answer
Have you done the APLS before *
Your place of work (Multiple ticks) *
Required
Your Position / Designation *
Your Consultant's or immediate supervisor's name *
Your answer
Currently are you working under a Paediatrician? *
Your Specialty *
Your Hospital *
Teaching Hospital
Provincial GH
District General Hospitals
Base Hospital A
Base Hospital B
Province you are working *
Institution of undergraduate medical degree *
Year of your internship *
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