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Prep Sessions for MRCOG II and III
Patients
Contact
Member Registration Form
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Member Registration Form
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First Name:
Last Name:
Sex
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Male
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DOB:
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Permanenet Address:
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Correspondence Address:
Phone - Mobile:
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Phone - Residence:
Phone - Office:
Email:
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Qualifications (University & Year of passing):
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Year of passing - MRCOG Part 1:
Year of passing - MRCOG Part 2:
RCOG membership No.:
KMC Registration No.:
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Current Designation and position:
Other memberships:
If trained in UK
Deanery of training:
No. of years spent in training in UK:
From:
To:
Specialization or special interest:
If so, ATSM/ Subspeciality:
If completed CCT when:
Year of relocation:
Do you still continue to work in UK?:
Yes
No
If yes, how often?:
Which activities of the trust would you like to support/participate in?:
CMEs
Community work
Conference planning
Guidelines
Website
How many hours a month can you spend on trust activities?:
Less than 2 hours
Around 2 hours
More than 2 hours
I wish to join BANGALORE RCOG TRUST as:
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Life member
Annual member
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