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.