MeDHa Application

Your Name (required)

Your Email (required)

Phone number (required)

Organization

Why would you like to participate in MEDHA2016?

What is the closest you have been to medical practice?
 I am working health professional One or more of my close family member is a doctor I wanted to be a doctor but.. I have researched a particular medical condition in detail and would like solve xyz problem Other

Are you able to attend on all four days?
 Yes No

I understand that I will have to pay Rs 2500 upon acceptance to confirm my place.
 Yes I am a full time student, I would like to be considered for partial fee wavier

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