Registration Form (Medical)Please fill in this online registration form - من فضلك، املأ هذه الاستمارة Name - الاسم الكامل * First Name Last Name Email * Mobile Number * Format: 9715xxxxxxxx Whatsapp number * Format: 9715xxxxxxxx Nationality * Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas (the) Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia (Plurinational State of) Bonaire, Sint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory (the) Brunei Darussalam Bulgaria Burkina Faso Burundi Cabo Verde Cambodia Cameroon Canada Cayman Islands (the) Central African Republic (the) Chad Chile China Christmas Island Cocos (Keeling) Islands (the) Colombia Comoros (the) Congo (the Democratic Republic of the) Congo (the) Cook Islands (the) Costa Rica Croatia Cuba Curaçao Cyprus Czechia Côte d'Ivoire Denmark Djibouti Dominica Dominican Republic (the) Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Eswatini Ethiopia Falkland Islands (the) [Malvinas] Faroe Islands (the) Fiji Finland France French Guiana French Polynesia French Southern Territories (the) Gabon Gambia (the) Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Holy See (the) Honduras Hong Kong Hungary Iceland India Indonesia Iran (Islamic Republic of) Iraq Ireland Isle of Man Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Korea (the Democratic People's Republic of) Korea (the Republic of) Kuwait Kyrgyzstan Lao People's Democratic Republic (the) Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands (the) Martinique Mauritania Mauritius Mayotte Mexico Micronesia (Federated States of) Moldova (the Republic of) Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands (the) New Caledonia New Zealand Nicaragua Niger (the) Nigeria Niue Norfolk Island Northern Mariana Islands (the) Norway Oman Pakistan Palau Palestine, State of Panama Papua New Guinea Paraguay Peru Philippines (the) Pitcairn Poland Portugal Puerto Rico Qatar Republic of North Macedonia Romania Russian Federation (the) Rwanda Réunion Saint Barthélemy Saint Helena, Ascension and Tristan da Cunha Saint Kitts and Nevis Saint Lucia Saint Martin (French part) Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten (Dutch part) Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syrian Arab Republic Taiwan, Province of China Tajikistan Tanzania, United Republic of Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Venezuela Viet Nam Virgin Islands, British Virgin Islands, U.s. Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Date of Birth - تاريخ الميلاد * MM DD YYYY Gender - الجنس * Male Female Profession - الوظيفة * Place of work - مكان العمل * How did you hear about us? - كيف سمعت عن المركز؟ * Google Facebook LinkedIn Instagram Twitter Al Waseet Word-of-mouth Which courses are you interested in?- ما هي الدورات التي ترغب بالإلتحاق بها؟ Check the boxes that apply and choose the training Central Sterile Supply Department (CSSD) Continuing Medical Education (CME) Choose course: Infection Control & Prevention (ICP) Central Sterile Supply Department (CSSD) Patient Safety Wound Care Intravenous Phlebotomy Venepuncture Therapy Management of Critically Ill Patients Airway Management Leadership & Management Skin Aging & Aesthetic Medicine Geriatric Critical Care in Homecare Nursing Telemedicine & Telehealth Percutaneous Endoscopic Gastrostomy (PEG) & Enteral Feeding Treatment of Traumatic Dental Injuries Non-Surgical Aesthetics Treatments Fundamentals of Aesthetic Dentistry Implant Retained Dentures First Aid - ASHI Choose course: Basic Life Support Advanced Cardiac Life Support Pediatric Advanced Life Support Heartsaver First Aid Certified Nursing Assistant (CNA) Choose preferred timing: Sunday 9 AM - 2 PM Sunday 3 PM - 8 PM Phlebotomy Technician Choose preferred timing: Sunday 9 AM - 2 PM Sunday 3 PM - 8 PM Payment method - طريقة الدفع Bank Transfer Credit / Debit Card (in-person) Cash (in-person) Emergency Contact Name & Number - اسم شخص ورقمه في حالة الطوارئ Terms & Conditions - الشروط والأحكام 1. You agree to pay all tuition due before the beginning of the course 2. You must attend all your classes as you will not receive any compensation for missed hours 3. No Fees Refund under any circumstances 4. You must provide us with a copy of your valid Emirates ID or Passport 5. To issue a Certificate you need to: a) Fill in the registration form. b) Provide a soft copy of your Emirates ID or Passport. c) Attend 90% of the training. d) Submit all required assessments. e) Fill in an online evaluation form. I accept Thank you! Your application has been submitted. A representative will contact you to finalize the registration.