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KasrAlAiny Faculty of Medicine Web

Services Registration Form


Please fulfill all fields then choose which one you want to be public
Photo
Personal Info:
√. Name: ………………………………………………………………
………………

√. Name in Arabic: ………………………………………………………………


………………

√. Department: ………………………………………

□. Sub-specialty: ………………………………………

√. Interest Fields: ……………………………………… ……………………


…………………

……………………………………… ……………………
…………………

√. Birth Date: ………………………………………

Contact info:
□. Home Address – Phone:………………………………………

□. Clinic Address – Phone: ………………………………………

□. Other Address – Phone: ………………………………………

□. Mobile Phone: ………………………………………

□. Website: ……………………………………… □. Wish to have


a website?

□. Other email addresses: ……………………………………………@………………


………………

……………………………………………@………………
………………

√. Desired email address :………………………………………


@kasralainy.edu.eg

Password will be delivered by a phone call or a


meeting?

Guidelines: short one, first letter of first name then last or


second name

Academic Info: to be filled in external papers


√. List of Publications:
Required format: Author (Date). Title of Article. Title of
Periodical, Volume, Pagination.

√. List of presentations:

√. Accomplishments / Achievements / Acknowledgments:

Please Send this to:


? Postgraduates affairs office ? Learning Resource Center ? Community
Services office

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