XX Annual Conference of IAPSM Organized by: Department of Community Medicine, UPUMS, Saifai, Etawah


Payment details:

NEFT in favour of: IAPSMUPUKCON-2017
A/C No: 728120110000149
IFSC Code: BKID0007281
Branch: Bank Of India, Saifai branch, Etawah- 206130
Note: Kindly submit the form online and provide us with transaction details to Email ID: iapsmupukcon2017@gmail.com

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Registration Details

 Name: Age:
Gender: Designation:
Institution / Organisation: IAPSM Life Membership no:
Pincode: Contact No(+91):  📞  
Email ID:   📧   WhatsApp No(+91):   📳  
Accommodation requirement: (Yes/No): Pre-Conference CME Registration (Yes/No):
Topic Preferred for CME: No. of accompanying person(s):
Details of co-delegates accompanying: Full Postal Address:
Whether Presenting Paper:      

Payment Details        

Conference Registration fee: (Rs)*      
Pre-conference CME/Workshop fee: (Rs)*      
Co-delegate fee: (Rs)*      
Accommodation fee (Advance): (Rs)*      
Total Amount Paid:(Rs)*      
Transaction Reference no.*      
Date of transaction*      
Drawn on Bank*      
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