Application Form for Palliative Care Award 2014 for SAARC Countries Instituted by Cancer Aid Society
CANCER AID SOCIETY, an NGO having Special Consultative Status with United Nations ECOSOC, working across India since 1987 on  Palliative Care, Advocacy, Tobacco Control, Cancer and Non Communicable Diseases Prevention and Control  invites Application/ Nominations from Doctors, Paramedical Staff and Social Workers with demonstrative leadership in the field of Palliative Care for the Cancer Patients from India, Bangladesh, Bhutan, Nepal, Pakistan, Afghanistan and Sri Lanka.  

Application can be made by filling this form online along with the references and verifiable evidences through media and pictures in order to identify the leadership of the applicants/ nominees to be sent by email to palliativecare@canceraidsocietyindia.org

Last date of Application is 24.00 Hrs. (India Time) of 8th December 2013.

PALLIATIVE CARE AWARD - 2014 (Rs. 100000. and Plaque) will be presented at the 21st International Conference of the Indian Association of Palliative Care - February 2014 to be held at Bhubaneswar India.

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Name *
Address *
City *
State *
Country *
Pin Code *
Phone Numbers *
Email-id *
Profession/ Designation *
Organization
Job responsibility *
Activities due to Job responsibility *
Whatever is required on account of your job.
Activities other than Job responsibility
Quantitative Achievements (On account of Job responsibility) *
Qualitative Achievements (On account of Job responsibility) *
Quantitative Achievements (Other than Job responsibility)
Qualitative Achievements (Other than Job responsibility)
2 References with phone number *
Contact us
Dr. DP Gupta
President
Cancer Aid Society
Head Office
First Floor, Regency Avadh Complex,
Chowk, Lucknow, UP. Pin - 226003
Phones: 91-522-2259157, 4043686, 3255278
FAX 91-522-2259239
Email : palliativecare@canceraidsocietyindia.org 
Website    : www.canceraidsocietyindia.org

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