Medical Electives Application Form


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Name (required)

Email (required)

Postal Address (required)

Nationality (required)

Age (required)

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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

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