Please Choose One and Check
Please Choose One and Check
Please Choose One and Check
Department of Health
East Avenue Medical Center
NATIONAL REFERENCE LABORATORY
East Avenue, Diliman, Quezon City
Tel. No./Fax No.: 435-7136; 433-0673 E-mail: Website: www.doh.gov.ph/nrl
PRE-REGISTRATION FORM
NOTE:
1. TYPE OR PRINT IN BLOCK LETTERS.
2. FILL UP ALL THE NECESSARY ENTRIES.
3. BRING THE PARTICIPANTS COPY DURING SEMINAR/WORKSHOP.
Name of Participant: (Family Name, First Name, Middle Name) Sex: Male Female
Name of Institution/Agency/Laboratory:
Mailing Address:
Contact Number
Telephone No.: Fax No. :
Cell phone No.: Email Address:
CUT HERE
Name of Participant:
PARTICIPANTS COPY
(Please bring and present this during seminar/workshop)
Republic of the Philippines
Department of Health
East Avenue Medical Center
NATIONAL REFERENCE LABORATORY
East Avenue, Diliman, Quezon City
Tel. No./Fax No.: 435-7136; 433-0673 E-mail: Website: www.doh.gov.ph/nrl
Rev. 6/18/08