Stop Sepsis | Save Lives - Sepsis Awareness Day

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This is a form to request for Registration to the Lecture/Discussion Program.
After you register you will receive the selection email if successful and then only you will be advised to make the payment. Without a valid email sent to your personal email the registration is not valid.

Surname/ Family Name *

(Please type only the Surname or Family name here)

Initials/ Other Names *

(Please type only the initials or other names here)

NIC No. *

Hospital attached to *

Unit attached to *

Designation *

Mobile No. *

Email Address *

Please remember to check if the email address is typed correctly.as your notification will come via the email.

Retype the email your address *

SSCCN Member *

Meal Type *

I agree to the terms and conditions of the organizing committee of SSCCN *

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