ReCos Gyne | Video Workshop | Event registration Form !

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ART OF FEMININE REJUVENATION:

8 October 2023
HOTEL ROYAL ORCHID
Durgapura, Tonk Road, Jaipur

https://drshraddhapcosclinic.in/ | Call for Enquiries: +91 80037 12888, 79760 88717

Title *

Dr.

Prof.

Mr.

Mrs.

Required

First Name *

Last Name

Hospital *

Address *

City *

State *

Mobile number *

Email ID *

Mode of payment :

Details for online payment or NEFT Transfer

Name: PCOSMETIC GYNE CLINIC
Bank Name : YES Bank | A/C No. : 103763200001016
Branch Mansarovar | IFSC - YESB0001037

Wallet Payment (Phonepe, GPay, Paytm etc) 9462955114

NEFT/Online Payment

Wallet Payment/UPI

Cash

Cheque

Others

I understand the event Terms and Paid INR 8000 to mentioned account, My Reference ID details are:

In case Payment via Cheque/DD: Mention in below form:

Cheque /DD No.: Dated:

Drawn on : Total Amount: `

Submit

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