IAPMRCON 2018 Pre-registration Form
Before Filling the Form, please read the instructions:
1. This is a Pre-registration form for the conference.
2. This form does not guarantee a seat in the conference.
3. Full Registration form along with fee shall have to be submitted for registration to the conference.
4. Approval of being a Faculty/Delegate for the conference shall be given by the Organizing Committee.
Email address
Are You a member of IAPMR
If yes, please quote the IAPMR Membership Number
Your answer
Title
Full Name
Your answer
Sex:
Postal Address
Please write the complete Postal Address here
Your answer
City
Your answer
PIN Code
Your answer
Country
Your answer
Telephone Number preferably Mobile
Your answer
Email Address for communication
Your answer
Qualifications
Your answer
Designation and Affiliating Instituion
Your answer
Number of Accompanying Persons Expected
Would be interested to present a Paper
Paper Type for Presentation (if presenting)
Title of the Paper to be presented
Your answer
Registeration fee Details
Please Check the registration fee Details on the conference website and send fee accordingly
Details of NEFT/DD/cheque
Amount, Number and Date of issue
Your answer
Please complete the captcha before submitting the form.
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms