In the application form provided below, fill up each box with relevant data only.
Each applicant must insert his/her own unique and genuine email address. This means that each member must have a unique email address by which he/she can be communicated by us.
In the 'User Email' box, please insert only one email address. Do not insert multiple email addresses in it.
Likewise, insert only one mobile number in the 'Mobile Number' box of 'E. Contact' section. Do not insert multiple mobile numbers.
For the address parts in the form we have provided separate boxes for 'City/Town/Village', 'State/UT', 'PIN' and 'Country'. So, please insert the details accordingly.
Those who are applying on behalf of an Organisation or Institution or any such body, must fill up the both 'B. Personal' and 'D. Organisation' sections.
Those who are representing only self, need to fill up the 'B. Personal' section only.
This section has to be filled by only those applicants who are representing an organization.
Corporate bodies = Rs 50,000; Palliative care organisations = Rs 50,000; Doctors = Rs 2,000; Nurses = Rs 1,000; Unpaid volunteers = Rs 500 (subject to certification by recognised institution in separate form to be send to us by post); Others = Rs 500; Overseas candidates = $100.
Cheques / DDs must be crossed and in favour of "Indian Association of Palliative Care", and payable at Bokaro Steel City, Bokaro, India.
Current Account No. 33808019294; IFSC Code SBIN0000246; State Bank of India; Bokaro Steel City, Sector - 4.
For payment related queries, please write to firstname.lastname@example.org