Aarogya Mammography Van Booking

• Name of the Rotary Club*

• Name of Contact Person*

• Email Id of Contact Person*

• Road Condition to Reach Camp*

• Expected No. of Patients to Attend the camp*

• Address*

• State*

• Booking Ammount*

  Rs. 10,000

• Date of Booking*

• Name of Camp Site*

• Distance from Sharda Hospital , Greater Noida*

• Contact No*

• Alternative No. if any Available

• City*

• Pincode*

• Mode of Payment*

  Online

  I accept terms & condition