Registration Form

Registration Data Update Form

Note: You need to ensure that www is included in the KIMS web site address to be able to submit the data. If you reached this page via an address that did not have it, please click here.

Submit data that need to be updated and data required in the sections marked with *: First Name:*, Surname:*, Registration No.:*.

1. Personal Information
First Name:*	Middle Name:	Surname:*

Registration No.:*

Sex: Male Female

Mailing Address:

Tel No.:	Fax No.:
Email address:	Mobile/Pager:

2. Qualifications
A.	Degree/Certificate:
	Institution:
	Year obtained:

B.	Degree/Certificate:
	Institution:
	Year obtained:

C.	Degree/Certificate:
	Institution:
	Year obtained:

D.	Degree/Certificate:
	Institution:
	Year obtained:

E.	Degree/Certificate:
	Institution:
	Year obtained:


Specialty:
Sub-specialty:

3. Employment Information
Date of Employment: (Date/Month/Year)
Professional Status:
Name of Hospital/Institution:
Employer Category:
Address:

ID No. Issued by Ministry of Health/University/Licence No.:
Email address:	Fax No.:	Tel. No.:

IMPORTANT
If you wish to re-enter data, press Reset. Please press Submit only once.
Your application will be processed and you will receive a message indicating the data you submitted. Please print this data sheet and keep the printout for future reference.
After you submit, contact the CME Office (Tel. 2410027 Ext. 107/159, Fax: 2467140, email: cmecenter@kims.org.kw to confirm your application has been received.

I hereby certify that the information mentioned above is true.

Site Map

Administration

KIMS Homepage