Hospital Group Executive Registration

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Hospital Corporate Group Executive Membership Registration

Name of hospital group

Number of hospitals

Address

District/ City

State

Pin Code

Phone

Contact Person Name

Landline Number

Mobile Number

Contact Person Email

Designation

Total Number of Beds

Location of corporate office

Website

Already existing Member ( Affiliate)

CIN number

CEO/Managing Director

Mobile

Password

Eight characters minimum One lowercase letter One uppercase letter One number One special character

Confirm Password

Subscription

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Total (Membership Fees + 5% Platform Charges + Taxes)

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Hospital Corporate Group Executive Membership Registration