CODE WHITE Registration Form

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CODE WHITE Registration Form

17th PEFRI Post Graduate Course

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* Indicates required question

Kindly indicate your FULL NAME (as shown in the Certificate) *

Your answer

Kindly indicate your email address *

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Kindly indicate your contact number *

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Kindly indicate your Designation *

Internal Medicine Consultant

Internal Medicine Resident

Family Medicine Consultant

Family Medicine Resident

General Physician

Nurse

Other allied healthcare practitioner

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Place of Practice *

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