Registration Form

Title

Prof.
Dr.
Ms.
Mr.

Full Name*

How you would like your name to appear on the Badge, Certificate and all records *

Email Id *

Mobile Number *

Designation

Affiliation (Institute / Hospital / Organization) *

Address of the organisation

Gender *

Meal Preference *

Country *

City *

State *

Pin Code *

Professional Registration Number (NMC,State Medical Council, RCI/NHPAC & Others)

Category *

Category Type

IPS Membership No. *

Old Number System

New Number System

LAM or LOM Membership no.

IPS Membership No. *

Accompanying Name *

Accompanying Relation *

Upload Document- Proof of Bonafide Student Status*

Do you want register Accompanying Person ? *

DOB *

Upload DOB Proof *

Add Pre Conference Workshop

Add Accompanying Person

Accompanying Registration Type *

Name

Gender

Meal Preference

Age

DOB (As per the ID Prof Like Aadhar Card, Passport & ETC)

Add More

Payment Details

Payment Mode *

Accommodation Payment Details

Total Nights*

Accommodation Total Amount *

Workshop Payment Details

Workshop Basic Fee *

Workshop GST Fee *

Workshop Total Amount *

Conference Registration Payment Details

Conference Total Amount *

Accompanying Payment Details

Accompanying Total Amount *

Total Amount *

Payment Date *

Registration is closed!..

Registration Form

Add Pre Conference Workshop

Accommodation Registration

Add Accompanying Person

Payment Details

Accommodation Payment Details

Workshop Payment Details

Conference Registration Payment Details

Accompanying Payment Details

Contact Details

Visitor Counter

Professional Conference Organizer