Aashayein - Let’s Celebrate Life Registration Form
Name of Patient *
Your answer
Mobile Phone Number *
Your answer
Email Address
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Age
Your answer
Talent you wish to showcase
Getting Hemodialysis where?
Your answer
Number of attendes other than patient (note that 1 attender per patient is free, more than 1 is charged at Rs. 750 per person) *
Your answer
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