KUACON 2022 - 27th State Annual Urology Conference
 4, 5 & 6th November 2022  (Friday, Saturday & Sunday)
Organized by: KUA Council
Venue: SSIMS & RC, Davangere
Request only delegate to fill the form. If any queries, please contact the Hon. Secretary
Email *
FULL NAME *
This will be used for issuing certificate
SEX *
MOBILE NUMBER *
Ideally number which has Whatsapp for any communication from organizing team
POSTAL ADDRESS *
Full address either of your Institution / Hospital / Residence including Pin code. 
This will be used for preparing GST invoice and  for correspondence. If you have GST number, mention that also
DESIGNATION *
Post graduate can mention which year. Full members can mention Consultant / Prof / HOD
MEMBERSHIP DETAILS *
Select one of these. PG student must be member of KUA to present papers or posters or participate in quiz
Required
KUA MEMBERSHIP ID No *
Please visit https://kua.in/  to know your Membership ID or to become a new member. If any clarifications contact Hon. Secretary
STATE MEDICAL COUNCIL No *
For example if registered in  Karnataka Medical council, please write  as "KMC 12345". Those who have come from other state say Kerala and studying PG in Karnataka will have registration number like "KRL 2012 0000123 KTK". This will be used for getting KMC credit points. Note: for SPOT registrations "No KMC credit points"
ACCOMPANYING PERSON (Above 6 years) *
Mention Full name and age for making registration badges. If more than 1, mention serial number wise. If none - write nil
T Shirt    size
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If willing to participate in Walkathon / Marathon (2K / 5K)
Date: 6th November 2022, 6 am to 7.30 am, SSIMS & RC grounds. 
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REGISTRATION REQUIRED FOR :
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CONFERENCE REGISTRATION DETAILS (Inclusive of GST 18%)
ACCOMMODATION REQUIRED *
Hotel booking has to be done through KUA only. KUA have blocked the hotel rooms in Davanagere. Pay using QR code/ NEFT
IF ACCOMMODATION REQUIRED 
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HOTEL TARIFF (inclusive of  GST)
HOTEL  ACCOMMODATION  RULES

Hotel tariff (Rs) are calculated for 2 days

There is no option to book hotel only for 1 day

Check in time 4th November 12 noon and check out time 6th November 12 noon

You can pay the tariff using QR code / NEFT provided below. 

Rooms will be booked based on 1st come 1st serve basis.

No accommodation will be provided for spot registration (subject to availability) 

REFUND POLICY (for both hotel and conference registration)
Up to October 10th - There will be full refund (after deduction of GST)

Between 11th October and 25th October - There will be 50 % refund (after deduction of GST)

After 26th October - No refund. 

Refund, if any, will be done only after the conference is over (within 15-30 days)
QR CODE
NEFT Details : Account Name : Karnataka Urology Association
TOTAL AMOUNT PAID *
(So  for eg. KUA member for registration and Budget hotel accommodation single occupancy for 2 days  have to pay till 30th September Rs 12980 only)
PAYMENT DETAILS *
FOR UPI PAYMENTS : ENTER UPI / UTR NUMBER / DATE / AMOUNT
FOR NEFT PAYMENTS : TRANSACTION ID / DATE / AMOUNT
(eg.. T22208020944060641487445 / 02-09-22 /  5000)
A copy of your responses will be emailed to the address you provided.
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