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Category of Registration
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Title
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First Name
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Middle Name
Last Name
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Date of Birth (dd/mm/yyyy)
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Gender *
E-mail *
Designation
Institution
City
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State
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Country
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Mobile Number
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Wish to add Accompanying Person(s)  *
Accompanying Person(s) Detail (Name, Age, Gender)
BANK ACCOUNT DETAILS
Account Name : Addiction Psychiatry Society of India
Bank : State Bank of India
Account No. : 42112607926
Branch : Subhash Marg, C-Scheme, Jaipur
IFS Code :  SBIN0031361

SCAN & PAY REGISTRATION FEES
Undertaking
I hereby undertake that the information provided above is correct.
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Kindly submit your Registration Fees as per category and choice. After successful transaction, please share successful payment receipt on E-MAIL id :  addicon2023@gmail.com  
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