Efficient, Quality-assured Data Capture using EpiData: Registration
Organized by The Union South-East Asia Regional Office in collaboration with AIIMS Bhopal, 09-10 April 2016
Please Complete All Questions. Do not leave any question / field blank.
In case a question / field is not applicable, please mark NA
Full Name *
Your answer
Sex *
Date of Birth *
MM
/
DD
/
YYYY
Email ID *
This will be the mode of communication for the course
Your answer
Contact Number (Mobile) *
Please start with +91
Your answer
Contact Number (Other)
Your answer
Address for Communication *
Please mention the full postal address including PINCODE. We will be mailing course certificate to this address.
Your answer
Highest Academic Qualification *
Years of Experience after completing post-graduation *
Your answer
Current Position *
Department *
Institute Name *
Your answer
Official Address *
Please mention the full postal address including PINCODE
Your answer
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