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Sign up for collaboration


Ophthalmologists who are willing to collaborate in this charity and non-profit activity, or willing to contribute to its costs can fill out the following form and sign up.
Sign up for collaboration
Full name:  
Major:
fellowship:
Medical council number:  
Age:  
Gender:
Cell Phone:
Phone:
Phone 2:  
Address:

    

    
Maximum days I am available to work at the clinic:
I would like to contribute Rials to the executive expenses of the clinic.