DCMS Alumni Grand Reunion 2019

Email *

First Name *

Middle Name *

Last Name *

Gender *

Male

Female

How do you relate to DCMS? *
Undergraduation
Post-graduation
Super-specialisation
Current Faculty at DCMS/OHRC/PEH
Ex-Faculty at DCMS/OHRC/PEH

Year of first joining DCMS? *

Current Specialty *

Designation? *

Hospital/Clinic Address *

Contact Number: *

Address Line 1: *

Address Line 2

City: *

Pin/Zip Code: *

State/Province: *

Country: *

RSVP- Are you attending? *

No, I cant make it.

Yes, I will be there.

Number of UGs and PGs (PURSUING from DCMS) attending - ₹ 1500/person * This discounted registration fee is ONLY for students currently enrolled as UG or PG at DCMS, to be paid to the respective batch representative via cash or online transfer ON or BEFORE 10th December, 2018
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Number of PGs who are DCMS alumni and PURSUING from OTHER colleges - ₹ 1800/person *This discounted registration fee is ONLY for DCMS alumnus currently enrolled as a PG STUDENT at any other institute, to be paid to the respective UG batch representatives via cash or online transfer ON or BEFORE 10th December, 2018
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Number of Adults (>15 years of age) attending - ₹ 2500/person *This registration fee is ONLY for those who have COMPLETED UG/PG from DCMS and are now PRACTICING. Registration fee to be paid to the respective batch representatives via cash or online transfer ON or BEFORE 30th November, 2018
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Number of children (5-15 years) attending - ₹ 1000/person *Registration fee to be paid to the respective batch representatives via cash or online transfer on or before 30th November, 2018
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Number of children (below 5 years) attending - free of charge *
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Are you also paying for an alumnus/alumni spouse or child/children? If yes, please mention name and batch below. *

Please upload your photograph/selfie 🙂 for the DCMS Alumni Global Database (Optional)*: