5 DAYS WORKSHOP IN DEEP ENDOMETRIOSIS SURGERY : 25 August to 29 August 2025

Email *
Name : Dr. *
Mobile Number *
Email : *
Complete Address, City State and Pin Code *
Passport Number & Expiry Date of Passport *
Meal Preference during workshop *
Required

GENERAL TERMS & CONDITIONS:

1.   No refund or discounts for unutilized services AND /OR in case of cancellation.
Airfare & rooms are non-refundable category.

2. CENTRE ENDOMETRIOSE TIVOLI & M/s JUPITER MEDICAL EVENTS accepts no responsibility other than what is mentioned in e-brochure. Further CENTRE ENDOMETRIOSE TIVOLI & M/s JUPITER MEDICAL EVENTS shall not be responsible for any loss, injury or damage resulting from acts of God, dangers, fire, breakdown of machinery, equipment or vehicles, acts of Government authority, wars, civil disturbances, riots, thefts, pilferage, epidemic, covid, quarantine or any delays or changes including any extra expense which the passenger many include as a result of any of the foregoing causes.

3.All bookings through Jupiter Medical Events only and a nonrefundable registration fee of INR 30000  at time of registration to the following account : 
BANK DETAILS :
Jupiter Medical Events
CA # 0912000100426901
Karnataka Bank - Branch : Andheri west Manish Nagar
IFSC code : KARB0000091
Amount : INR 30000.00

4. For academic details contact Dr. Prashant Mangeshikar 9820221321/  prashant@mangeshikar.com

*
MM
/
DD
/
YYYY
A copy of your responses will be emailed to .
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report