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 current place of work *
Your Position / Designation *
Your Consultant's or immediate supervisor's name *
Your answer
Currently are you working under a Paediatrician? *
Your Specialty *
Your CURRENT Hospital *
Which Teaching Hospital are you working at present
Which Provincial GH are you working at present
which District General Hospitals are you working at present
which "Base Hospital A" are you working at present
which "Base Hospital B" are you working at present
Province you are working *
Institution of undergraduate medical degree *
Year of your internship *
MM
/
DD
/
YYYY
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms