Registration Form
Title
*
Dr
Prof
Mr
Mrs
Ms
Full name
*
Profile Pic
(optional)
Email
Mobile (WhatsApp Number)
*
Designation
*
Affiliation/Institution
*
IAMM Membership
*
Yes
No
State Medical Council No. / MCI Reg. No.
*
Bonafide Certificate (for PG Students)
*
* Please upload file
Town / City
*
State
*
Postcode / Zip
*
Food
Veg
Non Veg
Drinks
Cocktail
Mocktail
Accommodation
Yes
No
Registration Category
*
Registration Amount
*
