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Pre Regisform

This document is a pre-registration form for a seminar/workshop on the Manual of Operations for Drug Testing Laboratories being held by the National Reference Laboratory of the East Avenue Medical Center. The form collects information such as the name, profession, institution, addresses, phone numbers, and email of the participant, who must choose if they are the head of a laboratory or an analyst. It also includes spaces for a registration number, signature of the receiver, and areas for the National Reference Laboratory to note the date and time received, and receipt information.

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chocoholic potchi
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92 views

Pre Regisform

This document is a pre-registration form for a seminar/workshop on the Manual of Operations for Drug Testing Laboratories being held by the National Reference Laboratory of the East Avenue Medical Center. The form collects information such as the name, profession, institution, addresses, phone numbers, and email of the participant, who must choose if they are the head of a laboratory or an analyst. It also includes spaces for a registration number, signature of the receiver, and areas for the National Reference Laboratory to note the date and time received, and receipt information.

Uploaded by

chocoholic potchi
Copyright
© Attribution Non-Commercial (BY-NC)
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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Republic of the Philippines Department of Health East Avenue Medical Center

NATIONAL REFERENCE LABORATORY


East Avenue, Diliman, Quezon City Tel. No./Fax No..: 435-71-36; E-mail: [email protected]

SEMINAR / WORKSHOP ON THE MANUAL OF OPERATIONS FOR DRUG TESTING LABORATORIES PRE-REGISTRATION FORM NOTE: 1. TYPE OR PRINT IN BLOCK LETTERS 2. BRING THIS REGISTRATION FORM DURING SEMINAR/WORKSHOP Registration No.: Date: Please choose one and check ( ) Head of the Laboratory Sex: PRC ID No. ( ) Analyst

Name of Participant: (Family Name, First Name, Middle Name) Profession: Name of Institution/Agency/Laboratory: Address (Laboratory): Address (Home):

Head of the Laboratory Telephone No.: Cell Phone No.:


NRL PRE-REGISTRATION FORM

Fax No.: Email Address:

--------------------------------------------------CUT HERE---------------------------------------------------Registration No.: Name of Participant: Total Amount Paid: Received by:
(Printed Name and Signature)

FOR NRL USE ONLY Date and Time Received O.R. No. & Date of Issuance

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