APPLICATION FORM FOR ASSOCIATE MEMBERSHIP - IAP INTENSIVE CARE CHAPTER

Proposer's Details

Qualification Details

(Attach supportive documents in pdf format only)

Qualification
Name of University
Qualifying Year
File (pdf only, Max 1MB )
a. GNM
b. BSC
d. Others

Associate Membership fees : Rs.1000/-

for correspondence
Dr. Vinayak Patki
Secretary, IAP Intensive Care Chapter,
Room No.526,Mother and Child Block,
Ushahkal Abhinav Institute of Medical Science,
Damani Road, Sangli,416415, Maharashtra
secretary@piccindia.com
9822119314 ​