Registration Form
Email *
Full Name *
Name with initials (Eg. Dr. X.Y.Z. Perera) *
Current Station *
Designation (Eg. MO, Public Health/ MO, Quality/ DMO, DH, X, etc.) *
Number of years of service *
Date of Birth *
MM
/
DD
/
YYYY
Telephone number *
Zoom Account User Name *
Remarks
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