Online Admission Registration Form

Kindly fill up the form below so that we can process your order 

eMail address:
First Name:
Last Name:
Address:
City:
State:
Zip:
Country:
Telephone:
Date of Birth:
Sex:
Marital Status:
Educational Qualifications:
Computer Literacy:
Whether Currently Employed:
How did you hear about Medi-KareOnline:
Payment Details: (Enter Bank Name)
DD/Cheque No.:
DD/Cheque Date:

One Time Payment : Rs. 18,000/- (Once you complete the above online form you will be redirected to the secure payment page for completion of your order via paypal)

DD/Cheque should be favouring Medi-kareonline

Kindly send your DD/Cheque to the below-mentioned postal address (If making payment offline):

Medi-Kareonline
C-418, 4th Floor, Kailash Esplanade,
Opp. Shreyas Cinema, LBS Marg,
Ghatkopar (W), Mumbai - 400086,
Maharashtra, India.

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