WHO Collaborating Centre for Research & Training in

Educational Development of Health Personnel

COLLEGE OF PHYSICIANS AND SURGEONS PAKISTAN

WORKSHOP REGISTRATION FORM FOR SUPERVISOR

IMPORTANT NOTE:
! Please fill the form, attach photo copy of Your NIC and submit at the CPSP REGIONAL
CENTER where you want to attend the workshop(s) along with Challan/Draft/Pay order. Please
turn over the page for addresses of CPSP Regional Centers.
! Kindly fill all the details required in the form. Incomplete and partially filled form will not be
accepted.
! If your personal details or address have changed (as may be the case with females after marriage)
or you have been transferred a move to new location, kindly fill: Personal Details & Address
Update Form” available at every Regional Center.

Have you already attended any One of your mandatory workshops? □ Yes □ No
Tick for Workshop Center where you want to attend workshop (Tick ONLY ONE Center)
□ Karachi □ Lahore □ Islamabad □ Peshawar
□Hyderabad □ Larkana □ Quetta □ Multan
□ Nawabshah □ Faisalabad □ Abbottabad □ Bahawalpur
Please tick against the title of workshop(s) you want to register for. You can tick more than one.
□ Educational Planning & Evaluation
□ Assessment of Competence
□ Supervisory Skills
□ Research Methodology, & Medical Writing
□ Others (Please Specify) _______________________________
Registration No. (For office use) D M E / /
PERSONAL DETAIL
Name:(in block letters) Father’s/Husband’s Name:
Old N.I.C. No. New N.I.C No:
CPSP Fellowship No: Date of Birth:

Designation: Speciality:

Institution:
Mailing Address:

Telephone: Off: Res: Fax No:

Mobile No: E-Mail:
WORKSHOP FEE DETAIL
Amount Rs. (In Words)

Challan / Drafts / Pay order No: Dated:

Bank: Branch
 ACADEMIC DATA

DEGREE / DIPLOMA INSTITUTION CITY YEAR

MBBS / BDS (Tick One)

Date: _________________________________________ Signature: _______________________________

REGIONAL CENTERS
Abbottabad Karachi Nawabshah
th
Ayub Teaching Hospital 7 Central Street, Defence Peoples Medical College for Girls,
Abbottabad Housing Authority, Karachi-75500 Nawabshah.
Tel: 0992-383330 Tel: 021-9207100-10 Tel: 0244-9370271, 0244-9370479
Fax: 0992-383330 UAN: 021-111-606-606 Fax: 0244-9370478
Email: cpspatd@hotmail.com Fax: 021-9266450 Email: rc_nawabshah@cpsp.edu.pk
cpspatd@yahoo.com Email: workshop@cpsp.edu.pk

Faisalabad Lahore Peshawar

Punjab Medical College,
Faisalabad
Tel: 041-9210366-8 (3 lines)
041-9210131
Fax: 041-9210224
Email: rc_faisalabad@cpsp.edu.pk
Next to Inmol Hospital,
Block "D", New Muslim Town,
Lahore
Tel: 042-9231320-8
Fax: 042-9231327
Email: rc_lahore@cpsp.edu.pk
Hayatabad Medical Complex,
Hayatabad Phase IV,
Peshawar
Tel: 091-9217011 / 9217320-1
Fax: 091-9217062
Email: rc_peshawar@cpsp.edu.pk

Hyderabad Larkana Quetta

Liaquat University Hospital,
Jamshoro / Hyderabad.
Tel: 022-3877393
Fax: 022- 2771303
Email: rc_hyderabad@cpsp.edu.pk
Chandka Medical College, Sandeman Provincial Hospital,
Larkana. Quetta.
Tel: 074-9410726 Tel: 081-9202424
Email: cpsplrk@hotmail.com Email: rc_quetta@cpsp.edu.pk

Islamabad Multan Bahawalpur

CPSP, Regional Center
P.I.M.S.
Sector G-8/3, Ravi Road,
Islamabad.
Tel: 051-9262590-1
Fax: 051-9262592
Email: rc_islamabad@cpsp.edu.pk
Nishtar Medical College, Quaid e Azam Medical College,
District Jail Road, Opp. Circuit Bahawalpur.
House, Tel: 062-2874940
Multan. Fax: 0621-2882489
Tel: 061-9200946 / 061- Email: rc_bahawalpur@cpsp.edu.pk
9200952
Email: rc_multan@cpsp.edu.pk