EndoThyro2018 SMC Registration Form
Live Operative Workshop on Endoscopic & Open Thyroidectomy
Shankus Medicity Hospital,
November 25, 2018
Email address *
Full name (First and Second) *
Your answer
Qualification (Degree / academics) *
Your answer
Category *
Name of Institute (For P.G Student / Resident)
Your answer
Address (Postal address with pin code) *
Your answer
Contact number *
Your answer
Registration charges
Bank Details
Bank A/c No : 50100073632609
Bank A/c Name : Keshav Charity Foundation
Bank : HDFC
Branch : Mehsana : 384002
IFSC Code : HDFC 0000238
DD/Cheque to be made in favour of "Keshav Charity Foundation" payable at mehsana
Registration Fee Paid (amount in Rs.) *
Mode of Payment *
Transaction ref. no. / Cheque no. *
Your answer
Bank Name (If applicable)
Your answer
Fees paid date *
Do you require accommodation and transportation facilities? *
I acknowledge that online submission of form does not guarantee registration. Fees must be fully paid prior to form submission. *
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