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APPLICATION FORM FOR LIFE MEMBERSHIP - IAP INTENSIVE CARE CHAPTER
Qualification Details

(Attach supportive documents in pdf format only)

Medical/Pediatric Qualification
Name of University
Qualifying Year
File (pdf only, Max 1MB )
a. M.B.B.S
b. D.C.H.
c. M.D. (Ped)
d. Others
Life Membership fees : Rs.3000/-
for correspondence
Dr. Dayanand Nakate
Secretary, IAP Intensive Care Chapter
Ashish Clinic, 347, South Kasaba, Main Road,
Solapur- 413 002, Maharashtra
Ph. 0217-2627447, 9850818650, email- nakated@yahoo.com

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