Registration

REGISTER NOW

Conference Registration Form

Rs. 0.00/-
Rs. 0.00/-
Rs. 0.00/-
Rs. 0.00/-
Please enter your full name
Please enter a valid age between 18 and 100

Please select your gender

Vegetarian Non-Vegetarian
Please select your food preference
Please enter your institute
Please enter your designation
Please enter your medical council name
Please enter your medical council number
Please select registration type
Please select your category
Please enter your phone number
Please enter your email
Please enter your address
Please enter your city
Please enter your pincode
Please enter your country
Please enter your state
Please select a workshop

Accompanying Persons

Travelling alone

Travelling alone?

You can opt to have your friends or family to accompany you.

Total Amount to Pay:

Please scan the QR code or use the bank details below to make the payment

Bank Details
Account Name ASSOCIATION OF CARDIAC ANAESTHESIOLOGISTS
Bank Name Punjab National Bank
Branch MVP COLONY,VISAKHAPATNAM
Account Number 4636002100004275
IFSC Code PUNB0463600
Please enter the transaction ID
Scan QR Code to Pay
Payment QR Code