Registration for "CME ONLY REGISTRATION " to the XXXVI Annual National CME in Pathology JNMC KLE Academy of Higher Sciences, Belagavi, Karnataka
Dear Delegates ,

This registration form is for delegates who wish to register for CME only ,

If you are willing to attend CME - kindly fill in the details as given below, in the "CME REGISTRATION FORM " via this google registration link / you can also mail a scanned copy of the registration form to

FOR WORKSHOP - (please contact for the availability of slots, prior to registration, as limited seats are available )
Delegates are requested to kindly send the scanned COPY of the registration form to our email or send as a courier to

Dr. Ramesh Chavan,
Organizing chairman,
36th Annual National CME in Pathology,
Prof & HOD, Dept. Of Pathology, J.N. Medical College, Belgaum- 590010, Karnataka

Delegates are also requested to note the amount for CME
Rs 3500 up-to 30/ 4/ 2018
Rs 4000 up-to 15/6/2018
Rs 5000 from 26/5/2018 - till spot

Payment details for IFSC / NEFT
Syndicate bank, Nehru Nagar, Belagavi.
A/c No 05042010106329
IFSC code SYNB0000504

For Offline registration -
DD / cheque should be drawn in favour of

Email address *
Name *
Sex *
Designation *
Medical Council Registration Number *
Medical Council Registering state *
College *
Address *
State *
email id *
mobile number *
Payment Details (kindly send UTR transaction number / DD number / cheque number ) *
A copy of your responses will be emailed to the address you provided.
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