Registration Form
IOA IFAS Course - 5th June 2022 - South Zone - Bangalore
Under the Aegis of Karnataka Orthopedic Association and the Bangalore Orthopedic Society
Conducted by the Department of Orthopedics, KIMS
Venue - KIMS Hospital Auditorium, KIMS, K.R. Road, V.V Puram, Bengaluru - 560004
For any Queries contact - ifassouthzone@gmail.com
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Email *
Name *
Designation *
Registration number *
State of Registration *
Address *
Institution
City *
Pin code *
Address for correspondence
Leave blank if same as previous address
Country *
Office phone number
Mobile number *
Email address *
Account Details
Account Name: KARNATAKA ORTHOPAEDIC ASSOCIATION REGD

Account Number: 04082010141791

IFSC Code: CNRB0010427

MICR Code: 560015227

NAME AND ADDRESS OF BRANCH:
CANARA BANK
204. CBS LAYOUT, VIAYANAGAR
BANGALORE
KARNATAKA-560040
Amount *
Required
Life membership number(IFAS/IOA)
Name of the Bank(If paid online write : Online) *
NEFT transaction number(If paid online write : Online) *
Date of Transaction *
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A copy of your responses will be emailed to the address you provided.
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