Registration Form
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Please Write/Type clearly/Use Block Capitals:

 

Family Name:........................................ First Name:..................................

Title: (Prof. Dr. Mr. Mrs. Ms):....................

Affiliation/Institution:................................................................................

..............................................................................................................

Mailing Address:.......................................................................................

P.O. Box:........... City:................. Country:............... Postal Code:.............

Tel:.................... Fax:.................... Email:................................................

  • I would like to register for the Conference and Workshop:
Registration Fee:

Early Registration
(Upto 28 February 2001)

- Physicians........... SR 1000.00
SR 800.00
- Health-team staff,
Technologists,....... SR 800.00
SR 700.00
- Students ........... SR 400.00
SR 400.00
  • I would like to attend Workshop only:
SR 200.00
SR 200.00

 

Visa Information

 

FULL NAME as shown in passport (include title):

_______________________________________________________

Passport No._______________ Date & Place of Issue:________
Date of Expiry:_____________ Date of Birth:_______________
Country of Birth:____________ Nationality:_________________
Nationality of Birth:__________ Marital status:_______________
Address (Work): Address (Home):
______________________________ ______________________________
______________________________ ______________________________
______________________________ ______________________________
Tel:___________ Fax:____________ Tel:___________ Fax:____________
Email: ________________________ Email: ________________________

 

City where you require the visa number to be sent (nearest Saudi Embassy or Consulate):

Suggested or Preferred Flight Itinerary:

_______________________________________________________

_______________________________________________________

 

Please return this form to:

The Organizer Department of Medical Biochemistry &
W.H.O. Collaborating Center (30)
College of Medicine & King Khalid Hospital, King Saud University
P.O. Box 2925, Riyadh 11461, Saudi Arabia
Tel: 966 1 4670831 Fax: 966 1 4672575
Email: mohsen@ksu.edu.sa