Advanced Trauma Life Support (ATLS) - Sri Lanka
Application form for ATLS
Email *
Student Course - (Please select month) *
Please select Year *
Title
First name *
Surname *
Name to appear in certificate *
Date of birth
MM
/
DD
/
YYYY
Nationality *
Primary medical qualification / degree *
University *
National medical council / licencing body *
Registration No. *
Current designation / position
Hospital *
Sri Lankan postgraduate trainee *
Postal address *
Contact phone number *
Email *
*
Required
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