SLSMLS Membership application

1. 1. Personal Details
a. Full Name:.............................................................................................................................................
b. Name with initials:................................................................................................................................
c. Personal address:..................................................................................................................................
d. Date of Birth:...........................................
e. Contact details: Mobile:................................ E mail:............................................................................
2. Professional Details
a. Working place:......................................................................................................................................
b. Date of first appointment:............................................... c. SLMC Reg No.:……………………………………..
d. Official Address(present):.....................................................................................................................
e. Designation:..................................................................................... e. Tel No:....................................
3. Academic Details:
 Degree (If Applicable)
f. Name of the degree:.............................................................................................................................
g. University:.............................................................................................................................................
h. Effective date of the certificate:...........................................................................................................
i. Post graduate qualifications:.................................................................................................................
 Diploma Awarded (If Applicable)
j. MLT School:...........................................................................................................................................
k. Effective date of the certificate:...........................................................................................................
l. Special trainings:....................................................................................................................................
4. Other Relevant Details:
……………………………………………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………………………………………
..................................................................................................................................... I do agree the
rules and regulations of the constitution of the Sri Lanka Society for Medical Laboratory Science.
Date: Signature
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Approval Office use only
Membership is accepted
President – SLSMLS Secretory - SLSMLS
Sri Lanka Society for
Medical Laboratory Science
Po Box 41, Maharagama / +94 77 3077717 / Fax: 0112689254
Medicallaboratoryscience.sl@gmail.com /
Membership No:
Membership Application

2. slsmls.org/ E mail:medicallaboratoryscience.sl@gmail.com/slsmls8205@gmail.com