Membership Form

*Registration Fees
Early Bird - 31/03/2020
Late Bird - 31/05/2020
Spot Entry
*Delegates
10,000/-
11,000/-
13,000/-
*Accompanying Person
8,000/-
9,000/-
10,000/-

For PG Students Rs. 8000/- only

  • * Registration fees does not include accomodation
  • * All fields mandatory. ** For PG students letter from HOD compulsary. Fees inclusive of all Taxes.
  • Cancellation accepted by 10th May 2020 only, refund will be processed 1 month post event.
  • Please carry a copy of Aadhar card during the conference.

Payment Details: Cheque/DD favoring "Association of Physicians A/C 139201000689"


Name Association of Physicians
Account Number 139201000689
Bank ICIC Bank
IFSC Code ICIC0001392
Branch Park Chowk, Solapur

Membership Form

Name & Contact Details
Surname *
First Name *
Middle Name *
MMC/MCI Registration No.
MRA/IRA No *
Mobile No *
Email *
Address
Address *
ZIP / Postal Code
State
Country
Accompaying Person Name
1 *
2 *