Conference Amount Focused Learning Session Acc Persons1 Acc Persons2 Acc Persons3 Survey Discount Net Amount GST (18%) Total Amount With GST
- 0 0

Registration Form

Personal Details
* Name
*Surname
* City
*State
* Age
* Gender
Contact Details
* Email ID
* Mobile No. +91
Whatsapp No.
Office No.
Residential No.
Member Type
*Member Type
Amount
18% GST
Membership No.
Medical Council Registration No.
Institute Name
Area of Practice
Focused Learning Session / Workshop (Only 25 Seats Per Focused Learning Session / Workshop)
Accompanying Person
Survey (Win exciting prizes by filling all 3 surveys - Prizes by lucky draw)

Survey 1 ( Monitoring ) - Click to fill the survey and get chances to win exciting prizes

Survey 2 ( Anaesthesia machine & Low flow anaethesia ) - Click to fill the survey and get chances to win exciting prizes

Survey 3 ( Airway ) - Click to fill the survey and get chances to win exciting prizes

Payment By

 

Cheque in favor of : VADODARA SOCIETY OF ANAESTHESIOLOGIST
You may send it to us on our registered address :
Dr Amit Shah (Secretary)
ISACON 2019 Vadodara
12/a, Gokul Society, Sindhwaimata road,
Pratapnagar, Vadodara-390004
Please mention Your name, contact details on backside of cheque.
NEFT/IMPS in favor of : VADODARA SOCIETY OF ANAESTHESIOLOGIST
account No.- 520101021377681
Bank Name - Corporation Bank
Branch Name- Vadodara - CPBB Branch(0616)
IFSC Code - CORP0000616
UPI in favor of : VADODARA SOCIETY OF ANAESTHESIOLOGIST
account No.- 520101021377681
Bank Name - Corporation Bank
Branch Name- Vadodara - CPBB Branch(0616)
IFSC Code - CORP0000616
Total Payable Amount :

Note * : Extra Charges (2% + 3 Rs. + GST) over the total payable amount is applicable on online payment transaction(instamojo)

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