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* Optional | Registration Fee Rs. 800 |
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*Registration No: |
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Name:
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Date of Birth: |
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Degree: |
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Professional
Qualification: |
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Specialization: |
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Facilities Available: |
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Contact
Information |
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*Residence: |
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Phone No.: |
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Mobile
No:
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*Fax: |
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*E-mail: |
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*Website: |
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Clinic / Hospitals: |
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*Working
Experience: |
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*Professional Membership: |
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Achievements: |
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*Awards & prizes: |
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*Courses
&
Workshops: |
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*Publications: |
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*Extra curricular Activities: |
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*A few words to the people as a doctor: |
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