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REGISTRATION FORM
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REGISTRATION FEE DETAILS
Category
*
*P.G. Student : Certificate from Head of the department confirming student status should be accompanied
Choose
ACRSI Member (Rs. 14,160/-)
Non-Member (Rs. 15,340/-)
P. G. Student* (Rs. 12,980/-)
Membership Number (mandatory for Member)
Your answer
First Name
*
Your answer
Last Name
*
Your answer
Gender
*
Choose
Male
Female
Designation
Your answer
Institution / Hospital
Your answer
City
*
Your answer
State
*
Your answer
Mobile Number
*
Your answer
E-mail
*
Your answer
Wish to add Accompanying Person(s) ?
*
Fees : Rs. 11,800/- per person
Choose
NONE
1
2
Accompanying Person(s) Detail (Name, Age, Gender)
Your answer
SCAN & PAY REGISTRATION FEES (UPI ID : merchant549711.augp@aubank)
Kindly submit your Registration Fees as per category and choice. After successful transaction, please share successful payment receipt through E-MAIL id : acrsicon2022jaipur@gmail.com OR WHATSAPP at +919413970800
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