Registration form for Online Workshop on Health Research Methods for Nurses and Allied Health Professionals
18 th Nov -20 Nov 2021
Sign in to Google to save your progress. Learn more
Name (in capital letters)
Gender
E-mail ID (This email will be used for all communication purposes) *
Mobile No ย (This ย mobile number will be used for all communication purposes) *
I am a *
If student - Please mention the name of your institution
If faculty - Designation, Department and Institution
City/Town
State
Pin code
Landline no
What are your expectations from this course?
If you are a doctor, please fill in your Medical Council Registration number
๐–๐จ๐ซ๐ค๐ฌ๐ก๐จ๐ฉ ๐Ÿ๐ž๐ž ๐š๐ง๐ ๐ฉ๐š๐ฒ๐ฆ๐ž๐ง๐ญ
๐๐ž๐Ÿ๐จ๐ซ๐ž ๐Ÿ๐ฌ๐ญ ๐๐จ๐ฏ๐ž๐ฆ๐›๐ž๐ซ - ย 
ย ๐‘๐ฌ.๐Ÿ๐Ÿ“๐ŸŽ๐ŸŽ/- (๐Ÿ๐จ๐ซ ๐ฌ๐ญ๐ฎ๐๐ž๐ง๐ญ๐ฌ) & ๐‘๐ฌ.๐Ÿ๐Ÿ•๐Ÿ“๐ŸŽ/- (๐Ÿ๐จ๐ซ ๐Ÿ๐š๐œ๐ฎ๐ฅ๐ญ๐ฒ) ย ๐š๐ง๐ ๐š๐๐๐ข๐ญ๐ข๐จ๐ง๐š๐ฅ ๐จ๐Ÿ ๐Ÿ๐Ÿ–% ๐†๐’๐“
ย 
๐€๐Ÿ๐ญ๐ž๐ซ ๐Ÿ๐ฌ๐ญ ๐๐จ๐ฏ๐ž๐ฆ๐›๐ž๐ซ - ย 
๐‘๐ฌ.๐Ÿ๐Ÿ“๐ŸŽ๐ŸŽ/-(๐Ÿ๐จ๐ซ ๐ฌ๐ญ๐ฎ๐๐ž๐ง๐ญ๐ฌ) & ย ๐‘๐ฌ.๐Ÿ‘๐Ÿ“๐ŸŽ๐ŸŽ/ (๐Ÿ๐จ๐ซ ๐Ÿ๐š๐œ๐ฎ๐ฅ๐ญ๐ฒ) ๐š๐ง๐ ๐š๐๐๐ข๐ญ๐ข๐จ๐ง๐š๐ฅ ๐จ๐Ÿ ๐Ÿ๐Ÿ–% ๐†๐’๐“

๐๐š๐ฒ๐ฆ๐ž๐ง๐ญ ๐œ๐š๐ง ๐›๐ž ๐ฆ๐š๐๐ž ๐ญ๐ก๐ซ๐จ๐ฎ๐ ๐ก:

๐Ÿ.๐๐š๐ฒ๐ฆ๐ž๐ง๐ญ ๐†๐š๐ญ๐ž๐ฐ๐š๐ฒ ย ๐Ž๐‘

๐Ÿ. ๐๐„๐…๐“
[๐›๐ž๐ง๐ž๐Ÿ๐ข๐œ๐ข๐š๐ซ๐ฒ ๐ง๐š๐ฆ๐ž: ๐’๐ญ. ๐‰๐จ๐ก๐งโ€™๐ฌ ๐‘๐ž๐ฌ๐ž๐š๐ซ๐œ๐ก ๐ˆ๐ง๐ฌ๐ญ๐ข๐ญ๐ฎ๐ญ๐ž;
ย ๐›๐š๐ง๐ค ๐ง๐š๐ฆ๐ž: ๐๐š๐ง๐ค ๐จ๐Ÿ ๐๐š๐ซ๐จ๐๐š;
ย ๐›๐ž๐ง๐ž๐Ÿ๐ข๐œ๐ข๐š๐ซ๐ฒโ€™๐ฌ ๐›๐š๐ง๐ค ๐€/๐œ #: ๐ŸŽ๐Ÿ“๐Ÿ๐Ÿ๐ŸŽ๐Ÿ๐ŸŽ๐ŸŽ๐ŸŽ๐Ÿ๐Ÿ’๐Ÿ—๐Ÿ๐ŸŽ;
ย ๐›๐ซ๐š๐ง๐œ๐ก: ๐‰๐จ๐ก๐ง ๐๐š๐ ๐š๐ซ, ๐’๐ญ. ๐‰๐จ๐ก๐งโ€™๐ฌ ๐Œ๐ž๐๐ข๐œ๐š๐ฅ ๐‚๐จ๐ฅ๐ฅ๐ž๐ ๐ž,
ย ๐Š๐จ๐ซ๐š๐ฆ๐š๐ง๐ ๐š๐ฅ๐š, ๐๐š๐ง๐ ๐š๐ฅ๐จ๐ซ๐ž-๐Ÿ“๐Ÿ”๐ŸŽ๐ŸŽ๐Ÿ‘๐Ÿ’;
ย ๐ˆ๐…๐’๐‚ ๐œ๐จ๐๐ž: ๐๐€๐‘๐๐ŸŽ๐’๐“๐‰๐Ž๐‡๐ (๐Ÿ“๐ญ๐ก ๐๐ข๐ ๐ข๐ญ ๐ณ๐ž๐ซ๐จ)]

**๐๐ฅ๐ž๐š๐ฌ๐ž ๐ฌ๐ž๐ง๐ ๐ข๐ง ๐๐ž๐ญ๐š๐ข๐ฅ๐ฌ ๐จ๐Ÿ ๐๐„๐…๐“ ๐ญ๐ซ๐š๐ง๐ฌ๐Ÿ๐ž๐ซ (๐ฒ๐จ๐ฎ๐ซ ๐ง๐š๐ฆ๐ž ๐š๐ง๐ ๐ญ๐ซ๐š๐ง๐ฌ๐š๐œ๐ญ๐ข๐จ๐ง ๐ˆ๐ƒ) ๐ญ๐จ - ย ๐ž๐ฉ๐ข๐›๐ข๐จ@๐ฌ๐ฃ๐ซ๐ข.๐ซ๐ž๐ฌ.๐ข๐ง ย ๐Ž๐‘ ๐ž๐ฉ๐ข๐›๐ข๐จ๐จ๐ง๐ฅ๐ข๐ง๐ž @๐ ๐ฆ๐š๐ข๐ฅ.๐œ๐จ๐ฆ

**๐๐ฅ๐ž๐š๐ฌ๐ž ๐ง๐จ๐ญ๐ž ๐ญ๐ก๐š๐ญ ๐ฐ๐ž ๐ฐ๐ข๐ฅ๐ฅ ๐ญ๐š๐ค๐ž ๐Ÿ•-๐Ÿ๐ŸŽ ๐ฐ๐จ๐ซ๐ค๐ข๐ง๐  ๐๐š๐ฒ๐ฌ ๐ญ๐จ ๐œ๐จ๐ง๐Ÿ๐ข๐ซ๐ฆ ๐ฒ๐จ๐ฎ๐ซ ๐ซ๐ž๐ ๐ข๐ฌ๐ญ๐ซ๐š๐ญ๐ข๐จ๐ง.
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms