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Registration Form
 

13th Annual International Continuing Medical Education Program
HIV Update at MediCiti Hyderabad India

 
August 19& 20, 2006 - MediCiti Institute of Medical Sciences, Medchal Mandal. Ranga Reddy District, AP
 
One registration per each form. Photocopies accepted.
 


      First Name    
      Last Name    
      Qualification    
      Address      
      City    
      State    
      ZIP Code    
      Home Phone    
      Work Phone    
      Institution    
      Institution Address     
      City State Zip    
      Department    
      Specialty    

 

*Program fees $25 (1000) . Please make check to CME/ SHARE and Mail registration form and payment to:

445 East North water Street apt#701
Chicago, IL 60611

For Indian delegates, kindly pay by cash or by Demand draft only in favor of SHARE INDIA PHMI payable at Hyderabad and mail the registration form to:

Public Health Management Institute
H.No. 6-1-126 & 127 (Ground floor)
Padma Rao Nagar
Secunderabad - 500 025
Andhra Pradesh, INDIA

 
 
Objectives - CME
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Program Sep 8th
Program Sep 9th
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