Course Registration Form

1
Full Name ( Correct Spelling for Certificate )* This field is required.
First Name
Middle Name
Last Name
2
E-mail* This field is required.
example@example.com
3
Phone Number * This field is required.
4
Affiliation & Institution* This field is required.
5
Nationality * This field is required.
6
Please Upload Personal Photo* This field is required.
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Max. file size: 10.6MB
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7
Please note that possession of a valid medical license (ترخيص مزاولة مهنة ) is a mandatory prerequisite for attendance at this Bootcamp. Please provide us with your licence number to complete the registration Process* This field is required.
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8
Registration for this Bootcamp requires successful completion of at least one of the following prerequisite exams: -Master's degree, 1st part. -Egyptian Board (Fellowship), 1st part. -MRCS, 1st part. Kindly upload documentation that verifies successful completion of one of the listed exams.* This field is required.
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9
Please Select your Scrub Suit Size* This field is required.
Please Select
Please Select
Large
XL
XXL
XXXl
10
Please Write Your Crocs Size* This field is required.
11
Have you attended any TBRI training programs before?* This field is required.
yes
No
12
Registration Fees : 10,000 Egyptian pound please send the required fees to instapay 01063612805 then keep a screen shot of your payment and upload it here to confirm your registration.* This field is required.
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Max. file size: 10.6MB
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