Registration Form

Full Name *

Gender *

Email Address * Important: Use a different email for each member. One email = One member only.

Mobile Number *

Designation *

Hospital / Clinic / Institute *

State *

MCI No / APMC No *

Registration Category

Veg / Non-Veg

Upload certificate from supervisor/ HOD of being a trainee

Accompanying Person Count

Total Amount (Inclusive of GST 18%)

Payment Mode

Registration Form closed