Name(Required) First Last Enter Number(Required)We will send all notifications (alerts, stipend, etc) on this number.Preferred City(Required)LucknowNoidaNew DelhiGhaziabadFaridabadAllSelect the cities where you're comfortable to participate in our camp.Are you registered under DCI?(Required)YesNoSelect if you're registered as a licensed practitioner under authorised government bodies.Are you currently active dental student studying in an Indian College recognised by DCI?(Required)YesNoRegistration Number(Required) Registration Certificate/ID(Required)Max. file size: 40 MB.Aadhar card(Required)Max. file size: 40 MB.Student ID card(Required)Max. file size: 40 MB.Consent(Required) I agree that my participation shall in no way affect my ongoing course and Dentist On Wheels shall not be liable to any damages whatsoever. Further, I declare that I am authorised to conduct clinical oral examination which would be duly cross checked by registered dental practitioner and under any circumstances I shall not prescribe medicines or treatment plan to the patients.Consent(Required) I hereby declare that no information has been concealed and is true to the best of my knowledge. I agree to the privacy policy & terms of service agreement.Signature(Required)
