Aesthetics Delhi

23^rd - 25^th August 2024
India Habitat Centre, New Delhi
2023 2019 2018 2017 Archive

Application form - Mentorship Program

Personal and Academic details

Mentorship Program *
Name *
Date of birth *
Age in completed years *
Correspondence email *
Correspondence address *
Home Phone Number *
Mobile Number *
Status (Resident/Faculty in Medical College/Independent practicing consultant)*
Membership number, years of membership of their respective society (Dermatology/ Plastic Surgery) *

Please tick on the Mentorship program you wish to apply for*

Surgery Non Surgery

Academic Details
- Year of Passing MBBS/ Institution *
- Postgraduate qualification (MD/Mch/DNB) / year of passing / institution*
- Post qualification experience and current position *

Details of congress

Conference registration number *
*Registration receipt to be attached/ if not yet registered please provide once you are registered – until we receive this we cannot grant the scholarship

Resume *

Allowed Formats (Max: 3MB)

PDF / DOC / DOCX / TXT

Upload proof of last 2 year's Presentation and Publications (upto 10 allowed)

Allowed Formats: PDF / DOC / DOCX / PPT / XLS / XLSX / GIF / JPG (Max: 3MB)

Brief write up about yourself *

Allowed Formats (Max: 3MB)

DOC / DOCX / TXT

Checklist for submitting the Form:

1. Mentorship Form

2. Detailed CV including details of publication and Presentations at conferences - oral / poster.

3. Proof of last 2 years publications and Presentations at conferences - oral / poster.

4. Brief write up on why you should be given this opportunity and what is your motivation for receiving this mentorship - (Not more than 250 words)

NEWS & EVENTS

Acne Scar Management
Vitiligo Surgery