IAPSM CONFERENCE 2020
Registration Form
Email address *
NAME *
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AGE
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SEX
DESIGNATION *
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INSTITUTION *
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CITY *
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PINCODE *
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STATE *
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MOBILE NUMBER *
Please share you mobile number without +91 country code
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MEDICAL COUNCIL REGISTRATION NUMBER & STATE WHERE REGISTERED *
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REGISTRATION DETAILS *
IAPSM/IPHA MEMBERSHIP NUMBER
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REGISTERING FOR *
PRE-CONFERENCE WORKSHOP CHOICE *
WORKSHOP 5 :: Universal Health Coverage & Health Systems
NOTE For WORKSHOP 5 :: Those who are applying should send their CV and one page write up as to why they want to attend. E-mail to be sent to workshopiapsmcon2020@gmail.com
REGISTRATION RATES
EVENT REGISTRATION
Pre-conference workshop charges extra @ ₹1,500 per person
Co-Delegates : ₹3,500/ person. Children below 10 years free
ACCOUNT NAME : Indian Assn of Preventive and Social medicine TN Chapter A/c IAPSM CON 2020
BANK : AXIS BANK
BRANCH : ROYAPURAM
ACCOUNT NUMBER : 919010057062943
IFSC CODE : UTIB0003352
SWIFT CODE : AXISINBB424

Please mail us confirmation of payment with your details.
On receipt of payment we will send your event pass via email shared above.
NUMBER OF CO-DELEGATES *
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DETAILS OF CO-DELEGATES *
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FOOD CHOICE *
PAYMENTS DETAILS - AMOUNT *
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PAYMENTS DETAILS - TRANSACTION ID *
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PAYMENTS DETAILS - BANK/BRANCH NAME *
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PAYMENTS DETAILS - DATE OF TRANSACTION *
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CONTACT NUMBERS FOR QUERIES
9444237927 | 9840300803
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