Well Wisher's Form


The Institute of Pulmocare and Research is striving hard and is poised to grow on its motto of research, education, and patient care. It has already marked its existence with a host of worthwhile activities.

Now it is our pleasure to invite you to kindly be a well wisher of the institute. We would treat your guidance, support, and patronage as our strength without keeping you in any financial involvement and bothering you with any administrative headache.

The institute will post its developments periodically to you to seek your guidance and support. It will try to offer its products and services to you in privileged ways.

Your support to this small and young institute is totally at the kind desire and discretion of yours. Please fill up the information format to be one of our revered well wisher.
Gender: Male Female
Date of Birth:
Full Address For correspondence:
Occupation, Experience and Present Position:
Phone Number:  
Mobile Number:
Select image to upload: Maximum File Size: 30KB
Select signature to upload: Maximum File Size: 30KB
Submitting the filled up information with a photograph will let us enrol you as our well wisher. It automatically implies that you have voluntarily opted to be so.

We wish to express our thanks to you.

Type the numbers for security purpose