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Online Registration

 

To,
The Webmaster,
www.batch81bjmcpune.com

I, the undersigned wish to join www.batch81bjmcpune.com as Member.

My details are given below.

I have deposited Rs. 500/- to  the Account of Dr. Kishor Gujar  { HDFC A/C No. -00071000203512 }

 (All Fields  are mandatory)
My Transaction ID :
 
Banker's Details :
 
  My Personal Details are as follows
 
Name : Surname Name Father's/Husband's Name
 
Qualifications: Degree / Diploma

1.  

Year :
 
Institute / University :
 

2.  

Year :
 
Institute / University :
 
Residential Address :
 

Tel. No. :
 

Fax No. :

  
 

Mobile :
 

E-mail ID :
 

Website :
 
Hospital Address :
    (Clinic/Consulting)
 

Hospital Tel. No. :
 
Attachments :
 
Special Interest :
 
Personal/Family
information


IMP: Please mail one passport size photograph and one family photograph with application form to webmaster@batch81bjmcpune.com  

INCOMPLETE INFORMATION MAY NOT BE UPLOADED

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  Webmaster : Dr. Nitin Deshpande                                                                                 Website Designed & Developed By : Manasi Creation