FamMed Essentials Certificate Course 

Registration Form


Name (as per National Identity Card or Passport)
Date of birth
Permanent address
City of residence
Country of residence
Contact number
Academic qualifications (degree/certification, institution, year of completion)
Professional experience (in number of years)
Why do you want to attend this course?
Are you currently employed?
How did you first learn about the course? (e.g. email, social media, website, word-of-mouth etc.)
Payment method (cash/online: https://payonline.aku.edu/)


                (i) I have read all the FAQs mentioned on the Family Medicine website.  
                (ii) I have filled the needs assessment survey attached on the website.