Name *

Age *

Email ID *

Gender * Select Male Female Other

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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

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

Prior publications based on thesis if any * 0/400

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

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Title of the Thesis *

Introduction * 0/400

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Methods * 0/400

Results *

Conclusion *