REGISTRATION FORM
Sign in to Google to save your progress. Learn more
REGISTRATION FEES (Kindly check your category)
CATEGORY *
TITLE *
Membership Number  (mandatory for IAP / ISPGHAN Member)
First Name *
Last Name *
Gender *
Designation
Institution / Hospital
City *
State *
Mobile Number *
E-mail *
Wish to Add Accompanying Person(s) *
Fees : Rs. 8000/- per person
Accompanying Person(s) Detail (Name, Age, Gender)
Wish to attend Workshop (7th October, 2022) *
NOTE : Conference Registration is mandatory
SCAN & PAY REGISTRATION FEES (UPI ID : merchant869772.augp@aubank)
Transaction Reference No.
Kindly inform successful payment transfer reference number
BANK ACCOUNT DETAILS (For Bank Transfer)
Account Name : PED GASTRO RAJASTHAN
Account Number : 2221221441208925
Account Type : CURRENT
Bank Name : AU SMALL FINANCE BANK LTD.
Branch : Mansarovar, Jaipur
IFS Code : AUBL0002214

UPI ID : merchant869772.augp@aubank

Kindly submit your Registration Fees as per category and choice. After successful transaction, please share successful payment receipt through E-MAIL at : ispghancon2022@gmail.com
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy