Workshop Registration

Workshop Registration Form

Basic Information
Title:*
Name:*
Department*
Email*
Email OTP*
Position*
Badge No*
Extension*
Mobile No
Saudi Council ID Number
Mail Code
Gender*
- Male
- Female
Hidden
Department's Head Name & Email
Hidden
Head Name
Hidden
Head Email (KSAU-HS or NGHA Email)
Workshop Details
Workshop Title:*
Date:
Date:
Date:
Date:
Date:
Date:
Date:
Date:
Date:
Date:
Date:
Date:
Date:
Date:
Date:
Date:
Date:
Date:
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Date:
Date:
From:

: Hours

Minutes

AM/PM
From:

: Hours

Minutes

AM/PM
To:

:

AM/PM
To:

: Hours

Minutes

AM/PM
Terms & Regulations
- Applicants will be informed with approval / disapproval before workshop conduction.
- Approved participants should be fully free from duty commitments during the hours of the training.
- Department Head approval is required.
- In case that the approved participant is unable to attend the workshop for any circumstances, the organizer must be informed on time to give the slot to others.
- Note: Your request will be sent to your Department’s Head and during the leave of absence, please add the designee's name and email address.
- For any inquiries or questions, please contact Ms. Amal Shutaywi Department of Medical Education Email: COMJ-MedEd@NGHA.MED.SA, Ext: 45854.
- By submitting this form, you agree to the terms and regulations.