Republic of the Philippines

Department of Health
East Avenue Medical Center
NATIONAL REFERENCE LABORATORY
East Avenue, Diliman, Quezon City
Tel. No./Fax No.: 435-7136; 433-0673 E-mail: Website: www.doh.gov.ph/nrl

SEMINAR / WORKSHOP ON THE

MANUAL OF OPERATIONS FOR DRUG TESTING LABORATORIES

PRE-REGISTRATION FORM

NOTE:
1. TYPE OR PRINT IN BLOCK LETTERS.
2. FILL UP ALL THE NECESSARY ENTRIES.
3. BRING THE PARTICIPANTS COPY DURING SEMINAR/WORKSHOP.

Registration No. Date:

Please choose one and check

Head of the Laboratory Analyst
AP AP CP Chemist Med. Tech.
CP Others ________________ Chem. Engr. Pharmacist

Name of Participant: (Family Name, First Name, Middle Name) Sex: Male Female

Profession: PRC ID No.

Name of Institution/Agency/Laboratory:

Address (Laboratory): Address (Home):

Mailing Address:

Head of the Laboratory: (Family Name, First Name, Middle Name)

Contact Number
Telephone No.: Fax No. :
Cell phone No.: Email Address:

CUT HERE

FOR NRL USE ONLY

Registration No.: Date and time Received:

Name of Participant:

Total Amount Paid: O.R. No. and Date of Issuance:

Received by: (Printed Name and Signature)

PARTICIPANTS COPY
(Please bring and present this during seminar/workshop)
 Republic of the Philippines
Department of Health
East Avenue Medical Center
NATIONAL REFERENCE LABORATORY
East Avenue, Diliman, Quezon City
Tel. No./Fax No.: 435-7136; 433-0673 E-mail: Website: www.doh.gov.ph/nrl
Rev. 6/18/08