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4th Dr. Advani’s Legendary Oncology Series (DALOS)
Delegate Registration Form |
24th & 25th August 2024, Mumbai
Theme: "Exceptional/Unusual Responses in Oncology"
Organising Chairperson : Dr. Suresh H Advani
4 CME Credit Points have been allotted for the conference
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Email
*
Your email
Title
*
Dr
Prof
Mr
Mrs
Ms
Required
Full Name (as you want on Conference Certificate)
*
Your answer
Specialty
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Medical Oncology
Surgical Oncology
Radiation Oncology
Hematology
Other:
City
*
Your answer
Mobile Phone No
*
Your answer
Medical Council Number (this is necessary if you want the CME Credits for the Conference)
Your answer
Registration Payment by Netbanking to
Bank Account Name - Kavina Creations LLP
Bank Account No - 50200044789221
Bank and Branch Name - HDFC Bank, Prabhadevi Branch (Mumbai)
Branch IFSC Code - HDFC0000012
Official Receipt of the Registration will be handed over to you at the Registration Desk during the 4th Dr. Advani's Legendary Oncology Series
Payers PAN
*
Your answer
Amount of Registration Payment Made
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Your answer
Registration Payment Transaction Number
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Your answer
Date of Registration Payment
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