Kingdom Of Saudi Arabia
King Fahad Medical City
Academic & Training Affairs
CPE Department
‫المملكة العربية السعودية‬
‫مدينة الملك فهد الطبية‬
‫الشئون األكاديمية و التدريب‬
‫التعليم المستمر‬
REGISTRATION FORM
KFMC Conference on
Physics & Engineering in Medicine
October 11 - 15, 2015
Please write clearly your Name, Saudi Council Number and Profession based on Saudi Council ID License.
First Name
:
Middle Name
:
Last Name
:
Gender
:
Name Of Hospital
:
MALE
()
FEMALE
CME Hours
on Process
()
Category / Specialty :
Saudi Council ID #
:
Cell Phone
:
Email Address
:
Target Audience:
NURSES and MIDWIFERY
Participants
Registration Fees
STUDENTS
Early
Late
Onsite
(on 11 Sept. 2015)
Oct. 11, ‘15
SR 500
SR 750
SR 1000
SR 150
SR 300
NO ONSITE for STUDENTS
Policy:
1.
As per Policy of Saudi Commission for Health Specialties (SCFHS) NO MORE Certificates will be issued after the activity
since all the Attendance will be uploaded in the Online Attendance of SCFHS Website. Click this site http://sascfhs.info/cmepdmember/search/ to print your CME Hours account.
2.
Incomplete information of SCFHS Number and Category/Specialty, the participant's name will not be uploaded in the
Saudi Council Online CME Attendance list.
3.
Attendance (signature) is a MUST. In case of NO Attendance, NO CME Hours will be given.
4.
Registration fees are non-transferable and refund will be deducted 20% of the amount of registration fee before three (3)
days of the activity date.
5.
No refund of registration fees ON or AFTER of the activity date.
6.
For Bank Transfer / Deposit, kindly send your bank receipt to the CPD office within three (3) days after payment either
thru fax / email for confirmation of your registration and write the Activity Title of the Event in the bank receipt.
7.
Bank Deposit, original slip must be submitted to CPD Office.
8.
Registration IS NOT CONFIRMED until payment is received.
9.
Saudi Commission for Health Specialist (SCFHS) Policy, students / interns are allowed to attend however, their names will
not be uploaded in the SCFHS Online CME Attendance list.
Mode of Payment:
ATM
Bank or ATM
CASH
: CPD Administration, ATA, 2nd Floor, Admin. Bldg., King Fahad Medical City
: King Fahad Medical City, Account No. SA9620000002480333359940 (Riyadh Bank)
: On the Day of the Activity
I hereby understand the above mentioned policies.
________________________
Signed Over Printed Name
For registration, please contact: CPD Administration @ Tel. No. : 011-288-9999 Ext. 10937 / 10928 / 10941 / 15059 / 10939 / 10935
Email: [email protected] Website: www.kfmc.med.sa For more information about the course: Please call +966-11-288-9999 Ext. 14670 / 17900 / 17086