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REGISTRATION FORM
ULTRASONOGRAPHY FOR GENERAL PRACTITIONERS

Co-ordinator : Antonette Minneι
Contact Details :  
  johan_antonette@freemail.asba.co.za

Tel : 011-828 6989 /  082 330 2927
Fax :
011-828 6989  / 011-548 8022
Address:
PO Box 98481, Sloane Park, 2152

Please confirm attendance by Monday, 11 February 2002 for Module 1 and Evaluation 1 (Pre-test).

Venues :
Module 1 & Evaluation 1 – Medical Sports Training Centre
Module 2 & Evaluation 2 – 130 Hendrik Verwoerd Drive
Module 3 & Evaluation 3 – Randburg
 


Return to : Antonette Minneι
Fax : 011-828 6989 / 548 8022

Personal Details:

Name: …………………………………………......................…. MP No. ……………..
Tel no: ……………………………………     Fax no:……………………………………
Cell no: …………………………………..      e-mail ……………………………………
Physical Address: ………………………..........................................………………….…
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Postal Address:…………………………………...............................................................
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Banking Details: Applications Training Consultancy; Nedbank Randburg; Branch Code: 198405; Acc no: 1984 546 783