Application form for the IAPC’s Foundation Course in the Essentials of Psychosocial Issues in Palliative Care (FCEPIPC)

The submission of applications for IAPC’s Foundation Course in the Essentials of Psychosocial Issues in Palliative Care (FCEPIPC) has been closed for the session.

Name of the candidate

First Name *

Middle Name

Last Name *

Qualification of the candidate

Select your qualification *
Doctor (MBBS / BDS)Nurse (BSc Nursing / GNM)Counsellor / Psychologist (BSc / MSc / MA in Psychology)Social Worker (MSW)

Upload your certificate *

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Contact details of the candidate

Your email address *

Your mobile number *

Address for correspondence with PIN code *

Name of the organization you are currently affiliated with

Address of the organization you are currently affiliated with

Scan the QR code to make payment

Please note that Cheque / DD / Cash will not be accepted.

UPI ID: IAPC399@SBI

Amount paid (Rs) *

Date of transaction *

Transaction number *

Name of your bank from where the transfer was made

Name of the branch of your bank

Upload transaction screenshot *

Only jpg, jpeg, png and pdf files of maximum 5 mb size allowed

Please prove you are human by selecting the flag.

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FCEPIPC Application Form

Application form for the IAPC’s Foundation Course in the Essentials of Psychosocial Issues in Palliative Care (FCEPIPC)

Name of the candidate

Qualification of the candidate

Contact details of the candidate

Scan the QR code to make payment

Phone

Email

Office

Working Hours

Application form for the IAPC’s Foundation Course in the Essentials of Psychosocial Issues in Palliative Care (FCEPIPC)

Name of the candidate

Qualification of the candidate

Contact details of the candidate

Scan the QR code to make payment

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