Nomination Form

Family Name/Surname
Given Name
Designation with Name of Organization
Mobile Number
Details of Achievements
Up-load Photograph (JPG/PNG)

Office Address
Residence Address
E-mail Address
Telephone
Up-load Resume or Profile (JPG/PDF)
Up-load Signature (JPG/PDF)

Dictation: I further declare that information provided in the nomination form is true to the best of my knowledge and belief.

Doctors play an inalienable and important role in the physical and mental health of people, making a profound impact on the lives of their patients and the overall fabric of society. One of their primary responsibilities is to provide medical care.

Mon–Fri8:00am–7:00pm

Sat-Sun11:00am–11:00pm

Contact:

Address:

2 nd Floor, 4384/4A, Tulsidass Street, Ansari Road, Darya Ganj, New Delhi 110002, India.

Get Directions

Phone:

9818222995, 9599337718

Email:

info@example.com

editor@example.com