New Registration Form - College of Pharmacy
I) Personal Details
Full Name
ملحوظة مهمه: الإسم الكامل (بالانجليزي)- الرجاء تحري الدقه لأن الإسم المدخل هو ماسوف يظهر عند إصدار الشهادة
Important Note: Please enter your full name (AR/EN) accurately. The name you enter will appear in the certificate.
First Name	* Invalid
Father Name	* Invalid
Family Name	* Invalid
ملحوظة مهمه: الإسم الكامل (بالعربي)- الرجاء تحري الدقه لأن الإسم المدخل هو ماسوف يظهر عند إصدار الشهادة
Note: If you're facing any difficulty to write your name in Arabic please seek the help of an Arabic speaking colleague to write it accuratly.
الإسم الأول	* Invalid- Only arabic letters allowed
إسم الأب	* Invalid- Only arabic letters allowed
إسم العائلة	* Invalid- Only arabic letters allowed
Saudi ID / Iqama No.	*
DOB	1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31  / 1 2 3 4 5 6 7 8 9 10 11 12  / 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008   Day / Month / Year
Place of Birth
Gender	Male    Female
Nationality / Country	Saudi    Non-Saudi
Mobile No.	+966  *  Invalid No.
Fax No.	+966  Invalid No.
Institution	KAAUH KFMC King Faisal Specialist Hospital and Research Center Prince Sultan Military Medical City Dr. Sulaiman Al Habib Medical Center (HMC) Dallah Hospital Kingdom Hospital King Fahad Medical City Other Ministry of Health Hospitals King Abdulla International Medical Research Center National Guard Health Affairs Security Force Hospital
II) Login Details
ملحوظة مهمه: الرجاء تحري الدقه لأن البريد الاكتروني المدخل سيستخدم للدخول الى النظام واستقبال التنبيهات
Important Note: Please enter your email account accurately. The email you enter will be used for login and system notifications.
Email	*  Invalid Email
Password	*
Confirm Password	*  Passwords do not match.
Today Date	27 Jul, 2024
	I verify my Name in AR and EN are correct
(*) Mandatory Fields