REGISTRATION FORM
 
 
 
PRIMARY TRAUMA CARE COURSE (PTC) Instructors
Indraprastha Apollo Hospitals, New Delhi - India
Fields marked with an asterisk * are mandatory.
 
Name
*
Institution & Department
 *
Address
*
Country
Post Code
 *
Phone number
*
Mobile Phone number
E-mail
 *
Registration Fee
5000 (Five Thousand)
Please Tick One
 2008 2009
Undertaking
I have understood the aims and objectives of the Primary Trauma Care Foundation and will work towards promoting the knowledge gained for better trauma care in my region.

I will also contribute by taking trauma courses organized by the PTC foundation outside my location
 
Signature and Date
  
 
Note.
1.Kindly send DD / Cheque in favour of "Primary Trauma Care (PTC) Foundation New Delhi"
2. Send completed form and cheque to:
Dr. Rajendra Prasad
Organizing Secretary
268, Sector - 15-A Noida .U. P. India
Pin :- 201301
 
 
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