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Registration for CSEP 2017
JUNE 28th - July 1st 2017
DEPARTMENT OF GENERAL SURGERY
ST.JOHNS MEDICAL COLLEGE AND HOSPITAL
Email address
Full Name
Address
Mobile/Contact number (Include Area Code)
Medical Council Registration No. (State)
Name of the State Medical Council
Date of Medical Council Registration
MM
/
DD
/
YYYY
Please check your Registration number as it is required for CME points. No changes will be allowed later.
Prices for rooms
Single occupancy Rs 780/day
Double occupancy Rs 545/day (Per-Person)
Registering for
No
Single occupancy
Double occupancy
Accomodation
Kindly Specify the dates for the accommodation below.
Workshop (First come First Serve basis)
FOOD
Veg
Non-Veg
Food
Mode Of Payment
Enter the amount below
By Demand Draft In Favor of "St Johns Medical College Hospital" Payable at Bangalore
Enter the DD number/NEFT or IMPS Transaction ID Below
Enter Date Below
MM
/
DD
/
YYYY
Enter the Bank Branch Below
For any queries ontact
Dr. Ann Sunny / Dr Vivekanandan
7829870367

Or Email :- csep2017@gmail.com

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