REGISTRATION FORM

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REGISTRATION FORM

34th ALL ORISSA CONFERENCE OF SRI AUROBINDO MEDICAL ASSOCIATION
Topic : THE NEW CHILDHOOD
9TH & 10TH, SEPTEMBER,2023 | VENUE: SARALA BHABAN, CUTTACK |

Name *

Age

Profession

Pediatrician

Obstetrician

Other Discipline

PG Trainee in Pediatrics

PG trainee in Obstetrics

Aspirant

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Mobile Number *

Email Id

Address

Accompanying Person

Doctor

Post Graduate

Aspirant

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Registration Fee

Doctor/Aspirant Rs. 500/-

Post Graduate Rs. 250/-

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Payment Method

QR Code

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Registration fee may be sent online to Account name:

SRI AUROBINDO SRIKSHETRA TRUST A/C SRI AUROBINDO MEDICAL ASSOCIATION

IDBI BANK LTD KABITA BHAWAN, COLLEGE SQUARE, CUTACK - 753003

SB Account No: 0217104000092889

IFSC: IBKL0000217

(Mention PAN & ADHAAR NUMBERS) Those sending online please collect your receipts from the registration counter for eligibility for tax benefits.

N.B.: All donations are eligible for 80G and 12A benefits.

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