3rd Lipidology Certification Course Registration

 

Course Selected

Personal Information

Contact Information
Correspondence Address (if different)
Yes

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Academic Qualification
Supporting Documents Check list
Degree Certificate
Proof of ID
Internship Completion
State Medical Council/MCI Registration
Proof of Address
Passport Photographs
Passport copy**
* for all conditional applications

**for international students

Payment Details
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Declaration
I Agree
I hereby confirm that the information I have provided on this application form is (to the best of my knowledge) true, accurate, current and complete; and I agree to notify Lipid Association of India promptly if any information contained on this application form should change, in order to keep it true, current and complete.

I hereby declare that I shall be disciplined and shall adhere to all the rules and regulations of LAI. I have read and fully understood the terms and conditions” given overleaf before filling in the application form and unconditionally accept them all binding on me.

I hereby undertake to pay all charges raised on account of services availed.