Member ID
:
Personal Information
Gender (choose one)
Male
Female
Date of Barth
Nationality
Nationality ID
Phone Number (without 0 at beg. of no.)
Email
Residence Address (governorate)
Amman
Irbid
Zarqa'a
Salt
Mafraq
Karak
Ma'an
Madaba
Jarash
Ajloun
Aqaba
Tafila
Other
Highest Degree
BSc
MSc
PhD
MD/PhD
Specialization
Lab General
Immunology
Biochemistry
Hematology
Anatomic Pathology
Genetics/Molecular
Quality
Blood bank
Other
Business Information
Applying as (choose one)
Lab owner
Non-owner
Lab Name
Lab Address (governorate)
Amman
Irbid
Zarqa'a
Salt
Mafraq
Karak
Ma'an
Madaba
Jarash
Ajloun
Aqaba
Tafila
Other
Practice Permit مزاولة مهنه (choose one)
Yes
No
Permit number
Permit Issue Date
Directorship Authorization certificate
Yes
No
Lab Directorship Authorization Number
Directorship Issue Date
Password
Uploads
Upload Personal Photo (high resolution)
Upload National ID Card
Upload Permit
Upload Directorship Authorization certificate
Save
