Kingdom of Saudi Arabia National Guard Health Affairs King Saud bin Abdulaziz University for Health Sciences

Saudi Physical Therapy Conference & Workshops 14 May 2012 (Workshops), Postgraduate Training Center 15-16 May 2011 (Conference), Riyadh Marriott Hotel

Registration Form PLEASE TYPE OR PRINT CLEARLY AS YOU WANT IT TO APPEAR ON YOUR CERTIFICATE OF ATTENDANCE AND RETURN THIS WITH PAYMENT.

TITLE:

Physiotherapist

GENDER:

Male

Student

Others:

Female

First Name

Middle Name

Profession/Specialty

Family Name

Saudi Council Professional No.

Institution

Telephone No. (Including Information Dialing Code)

Mobile No

Fax No.

Email Address

Mailing Address (City with postal code/country)

The deadline for Early Registration: Wednesday, 18 April 2012

CONFERENCE : 15-16 May 2012 Early Registration

Late & On-Site Registration

SPTA Members (present/attach SPTA ID)

SR 300

SR 400

Non-SPTA Members (Physiotherapists)

SR 350

SR 400

Students

SR 200

SR 250

Others (Physicians, Nurses & Technicians, etc.)

SR 400

SR 450

Category

WORKSHOPS : 14 May 2012 Please select one workshop (Limited seats) Workshop 1

Workshop 2

Workshop 3

A Neuro Restorative Approach to Rehabilitation in Children's with Cerebral Palsy

The Global Approach of Manual Osteopath

Management of wrist and elbow disorders

Early Registration: SR 400 Late Registration: SR 500

Early Registration: SR 400 Late Registration: SR 500

Early Registration: SR 400 Late Registration: SR 500

Important Information: 1. Registration is not confirmed until payment is received. 2. Payment is accepted in cash and bank transfer. 3. Deposit registration fee to: Account Name: ESC/Academic Affairs Account No. 01-08-00520891-009-1 IBAN: SA653040-01-08-00520891-009-1 Bank: Arab National Bank Khashmalaan Branch

4. Send payment and registration form or copy of your deposit slip to: Symposia & Conferences Division, Postgraduate Education and Academic Affairs Deanship, NGHA, P.O. Box 22490, Riyadh 11426, Saudi Arabia, Tel. No. +966 1 801-1111 ext. nos. 48459/48461 Fax: +966 1 2520040, Email: [email protected] 5. Cancellation/Refund Policy: Request for refund must be received one week prior to the conference. Administrative fee of SR50 or 20% of the total registration fee (whichever is greater) will be deducted from all refunds.

Please visit the event’s website: www.isaudiptc.com

Registration Form -

PLEASE TYPE OR PRINT CLEARLY AS YOU WANT IT TO APPEAR ON YOUR CERTIFICATE OF. ATTENDANCE ... Please select one workshop (Limited seats).

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