Registration Form - MAHATELEMEDICON 2022
Event Date: Saturday, 17th Sep. 2022
Event Timing: 09:00 am -04:30 pm
Event Address: Dr. D. Y. Patil Medical College, Pimpri
Sign in to Google to save your progress. Learn more
Name *
Email *
Mobile No. *
MMC Registration No. *
Fees
  • Early bird till 5/9/22 –Rs 400/-
  • 06/9/22 to 17/9/23 – Rs 500/-
Account Details

Current Account No: 111711011000038

Beneficiary Name: Dean, Dr. D. Y. Patil Medical College, Pimpri 18

Bank & Branch Name: Union Bank of India, Pimpri

MICR Code: 411011003

IFSC Code: UBIN0811173

Swift Code: UBININBBXXX

Contact No: 02027421765

Email ID: bm1117@unionbankofindia.com

Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of HealthLink Technologies Pvt. Ltd.. Report Abuse
Google Forms