Registration Form
Spotlight on
Primary Immune Deficiency Disorders


Sunday,  August 18th 2019
Kabani Hall,
Institute of Maternal and Child Health (IMCH)
Government Medical College, Kozhikode, Kerala

Registration fee           Till Aug 10th       After Aug 10th and spot
IAP member                     750/-                 1000/-
Non IAP member            1250/-               1500/-
PG student                       500/-               750/-

Online Transfer Details:
Indian Overseas Bank, Chevayoor branch
A/c Name: FPID (USA) Regional Diagnostic Centre for Primary Immunodeficiency Diseases
A/c No.089901000014519
IFSC Code: IOBA0000899

Please keep a copy of the Bank Transfer Acknowledgement Slip
Keep the details of the Bank Transaction with you before you proceed further
You will Require
1) Transaction ID
2) Transaction Date
3) Transaction Amount
4) Bank Name
Sign in to Google to save your progress. Learn more
Next
Clear form
Never submit passwords through Google Forms.
This form was created inside of IGIB. Report Abuse