Medical Electives Application Form


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Name (required)

Email (required)

Postal Address (required)

Nationality (required)

Age (required)


Sex (required)

Period of time you wish to come for (in weeks)

Dates you wish to come: First Choice(required)

Dates you wish to come: Second Choice(required)

Languages Known

Name of Institution where you are doing your medical training:

How many years of Medical Training you have completed?

What are the clinical subjects that you have done in rotation?

Briefly, what are your medical/professional/clinical interests?

What are the main objectives for your wanting to come to Lady Willingdon Hospital, Manali?

Contact Person and Address, in case of emergency

Any other information

Please enter the Code