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Course Registration Form: College of Physicians and Surgeons Pakistan Advance Skill Department

This document is a registration form for courses offered by the Advance Skill Department of the College of Physicians and Surgeons Pakistan. It requests information such as the applicant's name, designation, registration numbers, contact information, course and center preference, and fee payment details. The form also provides instructions on completing the registration and the department's fees policy, which notes that fees are non-refundable but allows for partial deduction in emergency situations.

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59 views

Course Registration Form: College of Physicians and Surgeons Pakistan Advance Skill Department

This document is a registration form for courses offered by the Advance Skill Department of the College of Physicians and Surgeons Pakistan. It requests information such as the applicant's name, designation, registration numbers, contact information, course and center preference, and fee payment details. The form also provides instructions on completing the registration and the department's fees policy, which notes that fees are non-refundable but allows for partial deduction in emergency situations.

Uploaded by

Anonymous FsIn1rxh
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
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COLLEGE OF PHYSICIANS AND SURGEONS PAKISTAN

Advance Skill Department


AHA & ACS Course Registration Form

Instructions:
Please complete this Registration Form for ASD Courses.
Tick appropriate box.
Status: Provider Instructor
2 Coloured
Refresher
Passport size
photographs
(5 x 6 cms)
with candidates
Course Center Choice: (Select One Centre Only) name on the back
Karachi Lahore Islamabad
Multan Peshawar Faisalabad
Abbottabad Hyderabad Others: __________
Title of Discipline: (can select more than one)
AHA Courses : ACS Courses:
Basic Life Support Course Advance Trauma Life Support Course
Advance Cardiac Life Support Course Rural Trauma Team Development Course
Pediatrics Advance Life Support Course
PERSONAL DETAIL
Name: Fathers/Husband Name:
C.N.I.C./Pass port No: Date of Birth:
Designation: Speciality:
PMDC Reg No: RTMC Reg No:
Institution:
Residential Address:
Phone (Home):
Cell No: E-mail:
COURSE FEE DETAIL
Amount Rs: (In words)
Challan / Drafts / Pay order No: Dated:
Bank: Branch:

Date: _________________________________________ Signature: _______________________________


ACKNOWLEDGMENT SLIP

This is to acknowledge that Dr. .

has been enrolled with the ASD in Provider Instructor Refresher Course
For Discipline, with the
Fees of Rs. .

.
Program Coordinator Date
Advance Skill Department
CPSP Pakistan

Fees Policy:
1. Fee is non refundable, but if there is any emergency, then there will be 25% deduction
first.

2. If any participant quit after the final selection and with in 10 days before the course then
he/she can appear in any next course but with the extra fees submission of 25% , if
he/she quit on emergency notification with in 48 hours before the course then 50%
charges will be fined, and if he quit on the day of the course then 100% charges will be
cut and he/she will have to re-register him/her self but after 06 months.

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