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
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