Reg. Form December 2019advancements-endourology.com/wp-content/uploads/2019/04/...Dr. Kandarp Parikh...
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Delegates Name (required) Designation / Qualication Spouse Name Institute USI Membership No. : Phone No. (Hospital) City E-mail State Cheque/DD No. Pin code ECS/NEFT Transaction No.. Mobile No. (Hospital) Sender Name Bank Name / City Category Address PG. Students should attach a letter from HOD as a Proof of belonging to that College / University. Please send cheque/DD (Payable at Ahmedabad) in favour of “Minimal Access Surgery Training Institute” (Registration Fees) You may Transfer registration form by email also on [email protected] and fees by ECS/NEFT also. Gujarat Medical Council accredition awaited. Bank Details : Account Name : Minimal Access Surgery Training Institute Account Number : 2811317766 IFSC Code : KKBK 0000812 Micr Code : 380485021 Bank Address : Kotak Mahindra Bank, Sanstar Building, Opp. Suvidha Shopping Centre, Paldi, Ahmedabad-380007. Dr. Kandarp Parikh Organizing Chairman Shyam Urosurgical Hospital 4th Floor Viva Complex, Opp. Parimal Garden Ellisbridge, Ahmedabad-380006, Gujarat, India Ph. : 079-26469846, 079-26466700 E-mail : [email protected] In case of any query please contact Ms Amita Bhavsar : +91 98256 57767 Ms Arpita Mehta : +91 98244 65767 Please Mention Your Transaction Details in Registration Form Registration Form For Online Registration : www.advancements-endourology.com 2019 Category USI Members Foreign Delegates PG Students st to 1 September 2019 th 30 November 2019 st 1 December 2019 Onwards st 1 June 2019 to st 31 Aug. 2019 Early Bird Offer up to st 31 May 2019 This Registration Fees includes 18% GST as per Government rules. Note : For Foreign Delegate Registration fees should be paid only by Credit card or Debit card . NEFT Facility is not available . 12000/- 7500/- 14000/- 8000/- 7000/- 10000/- 8000/- 5000/- US $ 180 US $ 200 US $ 150 US $ 125 13-14-15 December, 2019
Transcript of Reg. Form December 2019advancements-endourology.com/wp-content/uploads/2019/04/...Dr. Kandarp Parikh...
Delegates Name (required) Designation / Qualication
Spouse Name
Institute
USI Membership No. :
Phone No. (Hospital)
City
State
Cheque/DD No.
Pin code
ECS/NEFT Transaction No..
Mobile No. (Hospital)
Sender Name
Bank Name / City
Category
Address
PG. Students should attach a letter from HOD as a Proof of belonging to that College / University.Please send cheque/DD (Payable at Ahmedabad) in favour of “Minimal Access Surgery Training Institute” (Registration Fees)
You may Transfer registration form by email also on [email protected] and fees by ECS/NEFT also. Gujarat Medical Council accredition awaited.
Bank Details :Account Name : Minimal Access Surgery Training Institute
Account Number : 2811317766
IFSC Code : KKBK 0000812
Micr Code : 380485021
Bank Address : Kotak Mahindra Bank, Sanstar Building,
Opp. Suvidha Shopping Centre, Paldi, Ahmedabad-380007.
Dr. Kandarp ParikhOrganizing Chairman
Shyam Urosurgical Hospital4th Floor Viva Complex, Opp. Parimal GardenEllisbridge, Ahmedabad-380006, Gujarat, IndiaPh. : 079-26469846, 079-26466700E-mail : [email protected]
In case of any query please contact Ms Amita Bhavsar : +91 98256 57767 Ms Arpita Mehta : +91 98244 65767Please Mention Your Transaction Details in Registration Form
Registration Form
For Online Registration : www.advancements-endourology.com
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Category
USI Members
Foreign Delegates
PG Students
st to1 September 2019 th30 November 2019
st 1 December 2019
Onwards
st1 June 2019 to
st31 Aug. 2019
Early Bird Offer up tost31 May 2019
This Registration Fees includes 18% GST as per Government rules.
Note : For Foreign Delegate Registration fees should be paid only by Credit card or Debit card . NEFT Facility is not available .
12000/-
7500/-
14000/-
8000/-7000/-
10000/-8000/-
5000/-
US $ 180 US $ 200US $ 150US $ 125
13-14-15 December, 2019
