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    Registration Form Iiu

    Uploaded by

    Mushtaque Umrani
    The registration form is for a training course on treating substance use disorders from March 27 to April 5, 2016 at the Institute of Clinical Psychology at the University of Karachi. It collects basic contact and demographic information such as name, gender, date of birth, address, education level, work experience treating substance use disorders, and contact details in order to register applicants for the group or individual training course. It specifies that the completed form should be returned via email and lists the registration fee and contact information for inquiries.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Registration Form Iiu

    Uploaded by

    Mushtaque Umrani
    14 views1 page
    The registration form is for a training course on treating substance use disorders from March 27 to April 5, 2016 at the Institute of Clinical Psychology at the University of Karachi. It collects basic contact and demographic information such as name, gender, date of birth, address, education level, work experience treating substance use disorders, and contact details in order to register applicants for the group or individual training course. It specifies that the completed form should be returned via email and lists the registration fee and contact information for inquiries.

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    iiu

    Original Title

    REGISTRATION FORM IIU

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    The registration form is for a training course on treating substance use disorders from March 27 to April 5, 2016 at the Institute of Clinical Psychology at the University of Karachi. It collects basic contact and demographic information such as name, gender, date of birth, address, education level, work experience treating substance use disorders, and contact details in order to register applicants for the group or individual training course. It specifies that the completed form should be returned via email and lists the registration fee and contact information for inquiries.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    14 views1 page

    Registration Form Iiu

    Uploaded by

    Mushtaque Umrani
    The registration form is for a training course on treating substance use disorders from March 27 to April 5, 2016 at the Institute of Clinical Psychology at the University of Karachi. It collects basic contact and demographic information such as name, gender, date of birth, address, education level, work experience treating substance use disorders, and contact details in order to register applicants for the group or individual training course. It specifies that the completed form should be returned via email and lists the registration fee and contact information for inquiries.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
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    REGISTRATION FORM

    Training Course on Universal Treatment Curriculum for Substance Use (UTC 1 & 2)
    Institute of Clinical Psychology, University of Karachi
    March 27- April 5, 2016
    __________________________________________________________________________________________
    First Name: ________________Middle Name:______________ Last Name:_____________

    Female

    Marital Status: Single

    Married

    Gender:

    Male

    Date of Birth: ____________________________


    City:_____________________ Province:_________________
    Passport/CNIC No:__________________________________
    Mobile No: ______________ Office Phone No:_____________
    Email address:_______________________________________
    Name of Organization:__________________________________________________________
    GOV

    NGO

    Other _________________________

    Province of Organization:________________________________________________________
    Address:______________________________________________________________________
    Designation: ________________________________________ Years of Service_____________
    Experience in Treatment of Substance Use Disorder:_________________________________
    Academic Qualification:
    Primary

    Secondary

    Intermediate

    Graduate

    Masters

    Prost Graduate

    Other (specify)

    _______________________________________________________________________________
    Registration: Group Individual
    Registration Fee (PKR): ________________________
    Please return this form on this email ID: ([email protected])
    For further queries please contact: PTCL: 021 34984998 Cell: 0332 8209798
    ______________________________
    Signature of Applicant

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