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REGISTRATION FORM
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Conference Registration Fees for INDIAN and SAARC DELEGATES (Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan & Sri Lanka)
Category
*
NOTE :: PG Student - HOD's letter required for confirmation, kindly E-mail
Choose
Member (Hernia Society of India) [Fee : Rs. 14,160/-]
Member (Raj Hernia Society) [Fee : Rs. 14,160/-]
Non-Member [Fee : Rs. 16,520/-]
PG Student [Fee : Rs. 8,260/-]
Membership Number (mandatory for Member)
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First Name
*
Your answer
Last Name
*
Your answer
Gender
*
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Male
Female
Designation
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Institution / Hospital
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City
*
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State
*
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Mobile Number
*
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Whatsapp Number
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E-mail
*
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Wish to add Accompanying Person(s) ?
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NONE
1
2
Accompanying Person(s) Detail (Name, Age, Gender)
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Wish to attend Master Class (Paid)
*
Master Class will be held on 1st September, 2022 from 7.30 am to 11.00 am. Separate Registration Fees for each Master Class.
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NONE
Basic Hernias (Rs. 2,500/-)
Advanced Hernias (Rs. 4,000/-)
Hiatus & Diaphragmatic Hernias (Rs. 4,000/-)
Robotic Hernia repairs (Rs. 5,000/-)
SCAN & PAY REGISTRATION FEES (UPI ID : merchant621318.augp@aubank)
Kindly submit your Registration Fees as per category and choice. After successful transaction, please share successful payment receipt through E-MAIL id :
hsicon2022@gmail.com
OR WHATSAPP at +919829065573
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