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SULTARC – 12th Laser Competence Certification -2014 August 8th to 10th
All Courses are certified by Sharjah University & CME Accredited.
REGISTRATION FORM
Write name in PRINT (will appear on the certificate):
First_________________________________ Middle____________________ Last________________________
Academic Title / Specialization: _______________________________________________________________
Clinic/Hospital: ____________________________Country of practice _________________ P.O. Box _____________
Phone no: ___________________ Mob. No: ___________________ Email: _____________________________
Experience with Lasers: □ YES □ NO : If Yes, what kind of laser? _________________________
Please fill total amount of registered courses:
Laser Competence Certification in Aesthetic Laser -3 days of didactic lecture with
demonstrations.
August 8th -10th, 2014 (Friday-Sunday)
Clinical Attachment for Laser Competence Certification (Hands-on training)
From August 15th to 24th -Only during Weekends- Friday, Saturday, Sunday.
(Dates will be allocated by the organizers and sent to you once your application is
approved)
Bank Transfer Charges on Sender
TOTAL AMOUNT DUE =
AED/US $
3,500 AED /
1,000 US $
2,000 AED /
550 US $
Kindly tick any needed services below:
Hotel Assistance:
Transport Assistance:
Spouse Program (Shopping,
sightseeing, beaches)
YES:
YES:
YES:
NO:
NO:
NO:
Contact SULTARC:
Contact SULTARC:
Contact SULTARC:
ELIGIBILITY: WHO CAN APPLY?



Physicians- (Dermatologist, General Practitioners etc.)
Nurses
Laser Technicians, Aestheticians/Cosmeticians (If you want any particular licensing please check your certificates
with Licensing Authority first and validate your credentials for this course)
SULTARC – Sharjah University Laser Training and Research Center.
Email: [email protected] | Tel: +971 43 808200 | Mob: +971 50 3601940 | Fax: +971 43 808666 | www.sultarc.com
ADMISSION REQUIREMENT
1. Completely filled-in registration form (PLEASE WRITE IN PRINT)
2. Valid Passport copy (information with picture side) / ID card.
3. Copy OR Scan of Payment Receipt or Wire Transfer Receipt
4. Curriculum Vitae
5. Medical / Nurse / Aesthetician License copy (front & Back)
6. Candidate must provide proof of allied medical or aesthetician education (Certificate or Diploma)
REGISTRATION CONDITIONS
Registration will start on June 14th, 2014 and valid only after payment has been received by LCI.
The policy for refunding registration fees will be as follows:
 50% Refund 14 days before the start of the workshop.
 Notice for Cancellation, written request is required upon cancellation and will be processed one month after the
end of the course.
 No show without any notice will not be refunded
 If a candidate fails in the examination, they should re-apply and pay AED 1000 and should appear in the didactic
lecture with demonstrations again and re-write the examination.
 The Laser competence certificate will be issued only one time. If the certification is lost reapplication of a course
completion letter will be AED 1000.
PAYMENT DETAILS
Wire Transfer or Money Exchange to the Organizer:
Account Name: Light Care International FZE
Commercial Bank of Dubai, Sheikh Zayed Rd Branch, Dubai.
Account # 1000852234
Swift Code: CBDUAEAD
IBAN: AE470230000001000852234
Amount: ___________AED/US $
(Bank Transfer Charges on Sender)
AFTER PAYMENT
Registration form to be sent by: Fax: +97143808666 | Email: [email protected]
(Upon receiving your payment; we shall send the copy of receipt by e-mail or fax.)
DECLARATION
I hereby read and understood the eligibility criteria, registration and payment terms. I have enclosed all details needed
for my admission.
Name: ____________________________
Signature: ____________________________________________
SULTARC – Sharjah University Laser Training and Research Center.
Email: [email protected] | Tel: +971 43 808200 | Mob: +971 50 3601940 | Fax: +971 43 808666 | www.sultarc.com

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