JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Registration Form
13th Annual Workshop in Preclinical Imaging and Drug Discovery
* Indicates required question
Full Name
*
Your answer
Email
*
Your answer
Address
*
Your answer
City
*
Your answer
Country
*
Your answer
Gender
*
Female
Male
Phone number (WhatsApp)
Your answer
Profession
*
Student
Faculty
Scientist
Corporate
Other
Institution/ Organization
*
Your answer
Educational Qualification
*
Your answer
Bank Account Details for Payment
Account Name: Tata Memorial Centre - ACTREC
Bank Name: Central Bank Of India, Kharghar
Account Number: 1797305746
IFSC Code: CBIN0284047
SWIFT Code: CBININBBOSB
MICR Code: 400016114
Your answer
Registration Amount (INR) ( including GST)
*
3540 (Onsite Participation - Student)
5900 (Onsite Participation - Faculty)
11800 (Onsite Participation - Corporate)
Date of Transaction
*
MM
/
DD
/
YYYY
Transaction Reference ID
*
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
