Photo . ID Proof *

IMPORTANT NOTES:

  • Upload passport size photo in jpg or jpeg format only & Photo size should not be more then 100 kb
  • Passport size (3.5 cm x 4.5 cm) mandatory for conference badges, please upload scan/soft copy during registration.
  • Resize your passport photo >> click here
  • For PG Student, it is mandatory to provide / show student HOD letter.
  • For Senior Citizen it is must to provide / show the Age proof.

Registration Details
Registration Date:
Registration Type:
MCI / State Medical Council Reg. No FOGSI Member No:
Registration Fees:
Personal Information
Name : * *
Designation : Institute/Hospital: .
Address : * City : *
Pin Code : * Contact. No.: *
Email : * State : *
Country: Phone (R):
Mobile : *
Alert!
Gender:
Birth Date (dd/mm/yyyy):
Accompany Person
Title First Name Last Name Relationship Age * Gender ID Proof Delete
Add Associates / Accompany Person
Workshop
Registration for the conference is mandatory in order to register for the workshop
Full Day:
CME / Banquet
Service Name Total PAX
Name Fees No. of Members
OR
Payment Details
Member Fees : Accompany Fees :
Workshop Fees : CME Fees:
Banquet Fees :
Total CME/Banquet Fees : Total Amount :
Terms & Conditions
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