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