PLEASE ENSURE YOU WRITE THE CORRECT SPELLING OF YOUR NAME ACCORDING TO YOUR PASSPORT.
Title:
Mr.
Mrs.
Ms.
Dr.
Prof.
Gender:
Male
Female
Please Select:
[ Individual or Group - 5 Person or More ]
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Individual
Group (5 Person or More) - 20% Discount
Course Name: (Please don't remove the Course Name)
Date: (Please don't remove the Date)
Complete Name:
Hospital/Clinic:
Division/Department:
Position/Title:
Degree:
Nationality:
P.O. Box:
City:
City Code:
City Address:
Mobile:
Telephone:
Fax:
Email Address:
Registration Fee:
Early Registration: SR1,000
On Site Registration: SR1,200
Payment Information:
Payment Type:
Check
Cash
Transfer Bank Account
Bank Name: SAMBA Bank
Account Name: Riyadh Colleges of Dentistry and Pharmacy
IBAN No.: SA22 4000 0000 0021 0020 2782
Submit!