Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.1. Applying for *Male categoryFemale categoryTitle *DR,MR.MRS.MS.2. Name *FirstLast3. Sex *MaleFemaleOthers4. Date of birth *MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY202620252024202320222021202020192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925192419231922192119205. Attach Documentary Evidance in pdf size limit 1 MB for proof of date of birth *6. Present citizenship *7. Present postal address *8. Email *9. Mobile No. *10. Whatsapp *11. IPSA Life member registration No. *12. Details of abstract includes introduction, materials, results and conclusion: No headings or subheadings allowed. *13. Keywords (maximum 5; separate each keyword by comma) *14. Author details *First authorSurname *Given Name *Affiliation *Author details *Second authorSurname *Given Name *Affiliation *Author details *Third authorSurname *Given Name *Affiliation *Author details *Fourth authorSurname *Given Name *Affiliation *Author details *Fifth authorSurname *Given Name *Affiliation *Author details *Sixth authorSurname *Given Name *Affiliation * *I hereby read the terms and conditions of the award *The abstract submitted for the award was original research work carried out by me and has not been published or awarded earlier. *The same abstract has not been submitted for consideration of another award. *The award applied for currently has not been awarded to me previouslyUpload pdf attachment of forwarding note of the Head of the Department or supervisor *Submit Download Certificate
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