Request Form for Help with VISA-RELATED ISSUES by APPNA Young Physician & Advocacy/Legislative Committees
I herby authorize the chairs of APPNA Young Physician and Advocacy/legislative Committees to contact U.S Department of State, and other Government departments and legislative authorities (as deemed necessary) on my behalf.
Name *
Email *
Date of Birth (month, day, year) *
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Visa Type *
Visa Status *
Reason for Visa Application (specify exam name, elective, residency/research program - speciality, name, city, state) *
Passport Country Name *
Passport Number *
Visa Processing Number *
Place (City) of Interview *
Date of Interview (month, day, year) *
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DD
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Name of Medical College *
Brief Description *
Submit
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