2nd ISICPIM National Conference Registration

Application Id : 029

First Name*

Last Name*

Address

Gender

Male      Female      Others     

Mobile No*

Email ID*

Designation

Department

Institution or Organization

Degree

Medical Council Name & Registration Number*

Choice of Food

  Veg   Non-Veg

Registration Category *

ISICPM Member
Non Member
Postgraduates (* For Postgraduate Bonafide student certificate from head of department is mandatory.)

Select Workshop

Workshop 1 (USG & Fluroscopic Guided Perioperative Pain Intervention)
Workshop 2 (POCUS)
Workshop 3 (Basic & Advance Echocardiography)

No. of Accompanying Person (INR 2000+18% GST per head - Total-INR 2,360)

Choice of Payments *

  I accept and agree to the Terms & Conditions.

For any Query Regarding Registration Please Contact.

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Download Registration Form