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LAI Honorary Associate Member Registation Form
Full Name
*
Email
*
Mobile Number
*
Present Position
*
Qualification (Please mention your highest academic degree only)
*
Please upload a PDF copy of your highest academic degree only
*
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Medical Council Name & Registration Number
*
Please upload .PDF Copy of Medical Council Name & Registration Number
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What are your expectations from LAI, and how do you plan to contribute? (Maximum 100 words)
*
I agree to all the terms and conditions of LAI
*
Yes, I agree
No, I decline
Submit
For any question or concerns please free to reach us at:
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Home
About Us
Contact Us
Our Team
LAICON
Terms & Conditions
LAI TV
ALCC
LAI Store
Submit Abstract
New Member Application
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