REGISTRATION

Title:

Name:

Age:

Gender:

Address 1:

Address 2:

City :

State:

Country:

Delegate Type:

Phone :

Email:

Access code/Promo code:

Attending Days:

Day 1

Day 2

Day 3

MCI Number:

REGISTRATION FEES

Delegate	Up to June*	Spot Registration*	Day 1	Day 2	Day 3
Physicians	Rs.6000/-	Rs.7000/-	Rs.2000/-	Rs.2000/-	Rs.2000/-
Paramedics	Rs.4500/-	Rs.5500/-	Rs.1500/-	Rs.1500/-	Rs.1500/-
Academicians	Rs.3300/-	Rs.4300/-	Rs.1100/-	Rs.1100/-	Rs.1100/-
Researchers	Rs.3300/-	Rs.4300/-	Rs.1100/-	Rs.1100/-	Rs.1100/-
Medical Students	Rs.3000/-	Rs.4000/-	Rs.1000/-	Rs.1000/-	Rs.1000/-
Paramedical Students	Rs.2600/-	Rs.3600/-	Rs.800/-	Rs.800/-	Rs.800/-

*For all 3 days

To avail early bird registration

connect to +91 9496246200 | jpef@jothydev.net

PAYMENT METHODS

By Credit/Debit Card: Visa, MasterCard

By Bank Transfer: Please make drafts payable to:

P.KESAVADEV TRUST
Bank: STATE BANK OF INDIA
Branch Address: POOJAPPURA, LEKSHMI CHAMBERS, TRIVANDRUM, KERALA-695012
CURRENT ACCOUNT NO.67125332788
IFS CODE: SBIN0070032
Pan Number is AABTP0563E

For any other query, Please Contact

+91 9495346200, +91 9496246200