Para Medical Lab Education and Welfare Association

Membership Form

Upload Photo :

Name :

District :

DOB :

Age :

Gender :

Blood Group :

Permanent Address :

Mobile No :

Email ID :

Work Center (or) Lab Address :

Education Qualification :

Technical (CMLT/DMLT) Qualification :

Name of the Board :

Year of Passing :

Date :

Place :

Upload Document :

Required Lab Registration Certificate :

Required Not Requried

Maruthuva Aayvaga Malar Magazine :

Required Not Requried