Register – SLCHI

Personal Details

Surname*

Other names with title (as it should appear on the website)*

What name should your colleagues use to call you?*

Gender*

NIC*

Contact Information

Mobile No*

Residence No

Work No

E-mail Address*

Home Address*

Academic & Professional Qualifications & years obtained

Basic Medical Degree & Year (1MB Max)*

Medical Degree Certificate*

Upload

Latest SLMC Renewal Certificate (1MB Max)*

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Graduation Year of MSc in Biomedical Informatics

MSc Degree Certificate (1MB Max)

Upload

Graduation Year of MD in Health Informatics

MD Degree Certificate (1MB Max)

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Other /Overseas Qualifications & Years

Year of Board Certification from PGIM

Other Board Certifications

Membership Details

Category of Membership Applying for*

Membership Fee Payment slip (1MB Max)*

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User Account Details

Username*

Password*

Confirm Password*

Applicant’s Declaration

I affirm that I will neither abuse my enrolment status in the Sri Lanka College of Health Informatics, nor act in opposition to Sri Lanka Medical Council guidelines. I declare that there are no disciplinary inquiries or actions taken against me. I proclaim that I have perused the constitution of the College and that I will abide by it. I declare that particulars given above are accurate

I Agree

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