SELSI-SZCON
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Prefix:
Dr
Mr
Ms
Prof
First Name
Last Name
Category
SELSI Member
SELSI Non Member
PG
Hands-on Workshop
None
1st course (Animal Lab / Assend) - Rs. 3000
2nd course (Dry Lab) - Rs. 2500
Both Courses - Rs. 5000
Mobile
Email
Gender
Male
Female
Age
Institute / Hospital
City
State
* Medical Council Reg. No.
(Required Field)
Any Accompanying Person
Yes
No
Name of Accompanying Person
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