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Training Program Registration


The course fee doesn't include accommodation. Since only four candidates are taken in a batch, advanced registration is required.

Registration Form


1St Choice of date: (Refer Calendar)

2nd Choice of date:

First Name:

Surname:

Date of Birth:

Address



Name of Institutions

Designation

Tel No: Office :

Residence :

Fax No:

E. Mail:

Qualifications:

Previous Endoscopy Training if any:

Type of Endoscopy procedures presently doing: -

Facilities available at your center:  

I am sending a draft  (Payable to Dr. Pandit Palaskar)