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Advanced Trauma Life Support (ATLS) - Sri Lanka
Application form for ATLS
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Email
*
Your email
Student Course - (Please select month)
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Choose
January
February
March
April
May
June
July
August
September
October
November
December
Please select Year
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2024
2025
Title
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Dr
Mr
Ms
First name
*
Your answer
Surname
*
Your answer
Name to appear in certificate
*
Your answer
Date of birth
MM
/
DD
/
YYYY
Nationality
*
Your answer
Primary medical qualification / degree
*
Your answer
University
*
Your answer
National medical council / licencing body
*
Your answer
Registration No.
*
Your answer
Current designation / position
Your answer
Hospital
*
Your answer
Sri Lankan postgraduate trainee
*
Yes
No
Postal address
*
Your answer
Contact phone number
*
Your answer
Email
*
Your answer
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