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Registration

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*Membership Type :
*Name:
*Gender:
*Present Position:
*College Name:
*Date Of Birth:
*Country:
*State Registered In:
*DCI Reg. No :
*Email Address:
*Mobile Number:
*Blood Group:
Photo:

Communication Address

* Address:
*City/Town:
*State:
*Postal Code:

BDS Qualification

*Degree:
*College:
*Year Of Passing:

MDS Qualification

*Degree:
*College:
*Year Of Passing:

Dissertation /Thesis in brief

*Title:
*Summary:

Documents

Note:
  1. Get Ready with scanned copies (color) of your original cerftificates/documents in .jpeg/.jpg/.gif format.
  2. Each scanned copy size should not be more than 800KB.
  3. All Specified documents are mandatory.
  4. All the documents must be attested by any Gazetted Officer, Principal of dental college or HOD of dental college where you studied.
  5. Any deviation in mandatory documents and rules will resulting to rejection.

*Select Your Document:
Attach Your Document:
I am ready to pay Registration Fee.

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