Further Your Education for Free

Advanced Institute of Neurosciences -

Hyderabad unit

Online Program –Registration Form

( ) FELLOWSHIP
( ) DIPLOMA COURSE

PERSONAL INFORMATION
Name:
Muhammed Iqbal Elahi
Age:
43
Birthdate:
05/04/1978
Address: 9D, Tiljala Lane, Near Regal Nursing Home, Kolkata- 700019
Status:
Married
Religion:
Islam
Nationality INDIAN
and
Language:
ENGLISH,HINDI,URDU,BENGALI
Email:
iqbal.elahi9d@gmail.com
Telephone
No:
+919830373774

EDUCATIONAL BACKGROUND
YEAR COURSE/DIPLOMA

2019 PG Certificate Course on Acupuncture - Moxibustion

2021 Registered Acupuncture Practitioner Maharashtra Council Of Acupuncture
2022 BSc Psychology (2nd Year) University Of Madras
WORK EXPERIENCE
YEAR NAME OF INSTITUTION/ POSITION OR TITLE

Practicing Acupuncture at my own Clinic

Further Your Education for Free

How did you hear about this webinar/zoom class?

Social Media (V)
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Other: Through Whatsapp Group

CERTIFICATION
I, the undersigned, certify that the information submitted in this application describing my
qualifications are true and correct to the best of my knowledge.

That I understand the limitations of my practice and are subject to the laws of my country. By affixing
my signature, I acknowledge that this course aims to enhance my knowledge and skills and in no way
gives me a license to practice any part of Medicine or any means of treatment outside the scope of my
training and practice.

Wiwit Muhammed Iqbal Elahi

Wiwit Fitriya, Signature over printed name (Surname, First
October 27, 2020 Name, Middle Name)

Acknowledgement: (To be filled up by the country coordinator)

This application is accepted and approved by:

(Signature Over Printed Name)

Participant ID number: