3rd Lipidology Certification Course Registration


Course Selected

Personal Information

Contact Information
Correspondence Address (if different)


Academic Qualification
Supporting Documents Check list
Degree Certificate
Proof of ID
Internship Completion
State Medical Council/MCI Registration
Proof of Address
Passport Photographs
Passport copy**
* for all conditional applications

**for international students

Payment Details
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I Agree
I hereby confirm that the information I have provided on this application form is (to the best of my knowledge) true, accurate, current and complete; and I agree to notify Lipid Association of India promptly if any information contained on this application form should change, in order to keep it true, current and complete.

I hereby declare that I shall be disciplined and shall adhere to all the rules and regulations of LAI. I have read and fully understood the terms and conditions” given overleaf before filling in the application form and unconditionally accept them all binding on me.

I hereby undertake to pay all charges raised on account of services availed.