Name *

Age *

Email ID *

Gender * Select Male Female Other

Mobile Number *

Institute name with address *

Degree Course for which thesis has been/ is being submitted * Select DM Neurology DNB Neurology Equivalent degree from recognized institution of India DM (Neurology) or DNB (Neurology) or Equivalent degree Other

If other please specify *

Thesis Guide *

Date of submission of thesis expected date of submission *

Area of Research * Select Clinical Aspects Basis Sciences Allied Health Specialty

Prior Qualifications *

Has your work been presented at any conference * Select Yes No

Prior publications based on thesis if any * [Max 400 Words]

If yes, please state the conferences along with city and date

Authors *

Affiliations * [Max 400 Words]

Title of the Thesis *

Introduction * [Max 400 Words]

Aims *

Methods * [Max 400 Words]

Results *

Conclusion *