Registration for CSEP 2017
JUNE 28th - July 1st 2017
DEPARTMENT OF GENERAL SURGERY
ST.JOHNS MEDICAL COLLEGE AND HOSPITAL
Email address *
Full Name *
Your answer
Address *
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Mobile/Contact number (Include Area Code) *
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Current Institution
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Medical Council Registration No. (State) *
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Name of the State Medical Council
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Date of Medical Council Registration
MM
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DD
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YYYY
Please check your Registration number as it is required for CME points. No changes will be allowed later.
EARLY BIRD EXTENDED UP TO MAY 31st. REGISTRATION Rs2500/- TILL MAY 31
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 *
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By Demand Draft In Favor of "St Johns Medical College Hospital" Payable at Bangalore
Enter the DD number/NEFT or IMPS Transaction ID Below *
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Enter Date Below *
MM
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DD
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YYYY
Enter the Bank Branch Below *
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For any queries ontact
Dr. Ann Sunny / Dr Vivekanandan
7829870367

Or Email :- csep2017@gmail.com

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