Registration Form - Workshop on Quality Enhancement Support for NABH Preparation
Kindly fill below given details for registration to the workshop on Quality Enhancement Support for NABH Preparation which is scheduled from 24th June onward  every Friday 8 PM to 10 PM.
Registration fees for ASI member is Rs 2360/- and non ASI Member is Rs 5900/-. Payment can be made through DD / Cheque  to be drawn in favor of " The Association of Surgeons of India" or through NEFT / IMPS to the account " The Association of Surgeons of India" at Bank of Baroda , Name of Branch - Tiruvateeswa /Triplicane , Chennai.A/C No 0678 04 00 00 00 23
A/c Type - Over Draft , IFSC COde: BARB0TIRUVA (5th Character is numeric zero)
You can also inform about your completion of registration by email at nqepasi@gmail.com
Sign in to Google to save your progress. Learn more
Name
Postal Address
City
Cell Phone Number
Email ID
Current Work Location ( Name of Hospital)
Bed Strength of your hospital
Category
ASI Membership
If ASI Member , mention your membership number
Payment Details
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
Google Forms