Application for Refresher Course in Pain and Palliative Medicine - 2013

Please fill up the application form for refresher course in Palliative Care to be conducted on 7, 8 December, 2013 in Trivandrum and submit on or before 15 November, 2013. Please submit only one form. For any doubts please call 9746745499, Dr. Abu Laize C.B, Deputy Project Manager, Pallium India.

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    Educational Qualifications

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    Details of Application fee

    The application fees is Rs. 1000/-(including registration fee, tea, snacks, lunch and course material). Please fill in the details of fee paid. Write your name, address and mobile number in the back side of DD with signature.
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    Declaration

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    Please tell us specific topics or case scenarios that participants would like to be discussed
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    Thanks !

    Please review the information provided once again and click submit button to submit the application. Click the back button in your browser after submitting the form, take a printout and send to the following address along with DD/cheque Pallium India Trust (Refresher course) Administrative Office S - 10, Vrindavan Housing Gardens Opposite Traffic Police Station Pattom PO , Trivandrum - 695 004 Tel. & Fax +91 471 2440306, 4060554, 9746745504