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New Users' Registration Form
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(PDF Version - 63 K)Description & Example
National Dosimetry Services
New Users' Registration Form
Group Number: R12345
To ensure prompt processing and acceptance of your request by the National Dose Registry, please provide all Mandatory Information as described below.
- New Users' Registration Form
- Last Name
- Given Name(s) (complete, no initials)
- Social Insurance Number (9 digit numeric series)
- Sex
- Extremity
- Whole Body/Torso
- Head/Collar
- Extremity:
- Left Hand or Arm (below elbow)
- Right Hand or Arm (below elbow)
- Left Foot or Leg (below knee)
- Right Foot or Leg (below knee)
- Job (title of the
indivudual's job) - Date of Birth yyyy/mm/dd
- Place of Birth (province within Canada or Country outside Canada)
- Example:
- Smith-Jones
- Mary, Teresa
- 123-456-789
- F
- Whole Body/Torso & Left Hand
- Veterinarian's Assistant
- 1964/06/24
- Alberta
- Registration Form Completed by:
- Phone:
- Extension:
