Register – Radnova Club

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Personal Information

* First Name

* Last Name

* Date of Birth

Gender

Male

Female

* Username

* Password

Strength: Very Weak

Contact Information

* Email Address

* Phone Number

* Enter Phone Number

Academic Information

* Institution Name

* Current Year of Study

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* Student ID Number/ Roll Number

* Student ID Number/ Roll Number (If applicable, for verification)

Radiology Interests & Experience

* Interest Level in Radiology

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* Preferred Areas of Radiology

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* Previous Experience in Radiology (if any)

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* Agreement & Consent

Consent to Receive Emails & Notifications (Checkbox)

Agreement to Club Guidelines & Code of Conduct (Checkbox with link to club policies)