Registration Form for a Training Programme of the Nigerian Institute of Radiographers (a division of the Radiographers Registration Board of Nigeria)

REGISTRATION FORM FOR

MANAGEMENT WORKSHOP FOR RADIOGRAPHERS

1.

Theme: Total Quality Management Names in Full: (a)

Surname:………………………………………………………………………………………………………..

(c)

Middle Name:……………………………………………………………..………………………………..

(b)

Forename:…………………………………………………………………………….…………………………

2.

Status:

Radiographer

Non-Radiographer

3.

If non-Radiographer, please specify:…………………………………………………………………………..

4.

Qualifications obtained with dates:…………………………………………………………………………….

5.

Last date of renewal of annual practicing license:……………………………………………………….

6.

Official place of work:……………………………………………………………………………………………….

7.

Contact Address:………………………………………………………………………………………………………

8.

E-mail Address:………………………………………………………………………………………………………….

9.

Phone No(s):………………………………………………………………………………………………………………

10.

Rank/Designation:……………………………………………………………………………………………………...

………………………………………………………………………………………………………………………………..

Download, Fill and Scan to [email protected]