Transcript Document
REGISTRATION FORM
Saudi Arabia
PART (D) :
26 – 29 May 2007
CREDENTIALING EXAM: 1 Jun 2007
PART (B) :
30 May – 3 Jun 20007
Please
REGISTRATION FEES
the Part you want to attend
UP TO 2nd May 2007
AFTER 5th May 2007
SPTA* members
NoN- SPTA* members
PART B
SR 1,950
SR 2150
SR 2,150
PART D
SR 1,950
SR 2150
SR 2,150
CREDENTIALING EXAM
SR 1000
SR 1,300
SR 1,300
*SPTA : Saudi Physical therapy Association (www.SPTA.org.sa)
(Please print your name exactly as you want it to appear on your certificate of attendance)
FIRST NAME
:
MIDDLE NAME
:
LAST NAME
:
JOB TITLE
:
_____________________________________
CONTACT
INFORMATION
HOSPITAL/INSTITUTE
P.O. BOX
CITY
TELEPHONE NO.
FAX NO.
MOBILE NO.
E-MAIL
Date of registration
_________/________/_________
Note: Attending part A is a pre-request for part B
Attending part C is a pre-request for part D
Method of payment:
CASH, to Security Forces Hospital Program, Education & Training Dept. Office
Bank, Saudi British Bank – Account # 018000547002
Deposit slip must be attached
Please submit registration form to:
Education & Training Dept., Security Forces Hospital Program, P.O. Box 3643, Riyadh, Saudi Arabia.
Tel.: 966-1-4774480 Ext. 2411/2203/2201 Fax.: 966-1-4784755 or 4774480 – 2221
Email:
[email protected] or [email protected]
Please Note: Pre-course reading material will be sent to those who register before 2nd of May
Those who register after 5th of May, will receive it on the first day of the course