Training – 1 year course – Registration Form

Application and Agreements of Preceptee for the Fellowship in Gynecologic Endoscopic Surgery

Representations and Warranties
By applying for appointment as PRECEPTEE, I represent and warrant that:
1. All information submitted by me in this application is true to the best of my knowledge and belief.
2. I agree to practice my profession according to the professional and ethical standards of my specialty.
3. I have satisfactorily completed MD/DGO and have Indian Medical council Registration.

Kindly send the demand draft in favour of ‘Cochin gynecological endoscopic and infertility training centre’ payable at Ernakulam.
Dr. Paul P.G,
Paul’s Hospital, Kaloor, Cochin 682017
Kerala, India
Ph: 0484-2344446, 2344447

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