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Full Name [Without Prefix] *

Gender *

Age (in year) *

Country (ITEC Countries) *

Institute/organization *

Current organization *

Highest Level of Education *

Occupation *

Other Occupation *

Current Designation *

Level of Operation *

Total experience in healthcare profession? *

Total experience in management /leadership roles? *

Year Participated in IPHMDP *

Your Designation when Attended IPHMDP *

Have you received any formal management training before coming to IPHMDP? *

Name *

Organization *

Duration *

Weblink

Profile Photo [ jpg, png, less than 1MB] *

Email Id [User as Login Id] *

Password [between 6 to 20 character] *

Re-Enter Password *

I consent to participate in this study. I have no objection of getting it published. *