Application for Local Council
Select Position
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President
Vice President
Treasurer
General Secretary
Project Director Malaria and Dengue
Project Director Hepatitis B & C and HIV
Project Director Tuberculosis
Project Director Hepatitis A&E and Typhoid
Project Director Community Awareness (VCAN)
Project Director Research and Publication
Media Secretary
Volunteer Resource Secretary
Project Support Secretary
Personal Information Section
Name
*
Contact #
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Email
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Education and Experience Section
Institute Name
*
City
*
Province
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Degree
*
MBBS
BDS
Pharm D
DPT
B. Sc. (Hons.) Biotechnology Technology
B. Sc. (Hons.) Medical Laboratory
B. Sc. (Hons.) Dental Technology
B. Sc. (Hons.) Dental Hygiene
Other
Year of Study
*
Final Year
4th Year
3rd Year
2nd Year
1st Year
Other
Past Volunteer Experience
*
Yes
No
*
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