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Registration Request Form IMPACT 2023
Thank you for your interest to Register for IMPACT 2022. Please fill out this form and await further instructions
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Email
*
Your email
Type of Registration
*
Choose
Indian Armed Forces Delegate ₹ 1000/-
Civilian Delegates ₹ 1500/-
Speakers/Resource Persons
Option 4
Cell Number ( Whatsapp)
*
Your answer
Name
*
Your answer
Specialty
*
Your answer
Designation/ Appointment
*
Your answer
Preferred name on the certificate
(With Rank/Title, if applicable)
*
e.g. Dr Sandeep Kumar
Your answer
Institutional affiliation & Address
*
Your answer
Address for communication
Your answer
Country
*
India
Other
Any additional information or message
Your answer
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