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. Sachin Shah
Secretary, IAP Intensive Care Chapter,
S.No. 8,
Surya Mother and Child Superspeciality Hospital,
Near Hinjewadi Flyover, Wakad, PUNE, 411057,
Maharashtra, India
secretary@piccindia.com
98505 66196 ​