<%OPTION EXPLICIT%> MVUPGO : Registration Page <% if Request.QueryString("courseid")="" OR Len(Request.QueryString("courseid"))>2 then %>

Sorry. No course was selected.

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Online Examination System 
 
Student Registration for <%= retCourseName(Request.QueryString("courseid")) %> course

Enroll yourself into the MVUPGO students database! Fill up the form below and click the button at the end of the form.
*Please create a g mail address with your fist name exclusively for this course as shown.
Your first name-mvupgo@gmail.com
eg, muthusamy-mvupgo@gmail.com
All my students must have mvupgo in their e mail address.

You have to fill in ALL of the fields.

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Exams you would like to appear for and when :
Fullname :
Address me as : *
  * I address all my students by the first name. How would you like me to address you?
 

Technical Information - the following information is needed to enable you to access www.MVUPGO.com. Please use an easy-to-remember username and password.
 
Username : (no spaces)
Password :      Confirm Password :
Email :


 
Sex : Male       Female
Race :
Date of Birth : <% Dim boolCallFun %> ,
Degree :          Year of Graduation :
College / University :
Academic Medals & Prizes Received :
 
Place of Work :
Postal Address :
 
Experience in Ophthalmology :
 
Ophthalmology exams you have written and you have passed (with dates). :
 
Marital Status   : (If married, please state educational status and current occupation of spouse)

 
How fluent in English is your spouse (if married):   :
 
Children / Age
(eg John / 10)
:
 
 
Any doctors in the family? :
 
Any specialist in the family? :
 
Parents' Occupation  
 
Goals And Aspirations  
 
 
How did you know about this course?  
 




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