• +91 94138 32331, +91 94140 36561
  • cuticon23@gmail.com
  1. Home
    2. /
  2. Registration Page

Registration Form

(for office use only)
Medical Council Number
Designation
State:
Country:
Mobile
Registration Fees Details
Category Upto 30th. september, 2023 From 1st. October, 2023 & Spot
IADVL Member 3000/- Rs. 4000/- Rs.
Postgraduate Student 2000/- Rs. 3000/- Rs.
Accompanying Person 2000/- Rs. 3000/- Rs.
Registration with Accommodation at Venue: Single Room 28,000/- Double Room 35,000/- (Check in -27 th Oct, Noon Check out - 29th Oct, 11.00am) Inclusion Dinner - 27th & 28th Oct; Lunch & Breakfast - 28th & 29th Oct. Extra Bed will be Charged directly by Hotel as per Policy
Accompanying Person Details
NO. Name Age Sex Veg / Non Veg
1
2
3
4
OR
NEFT & RTGS Details: RAJCUTICON -2023

Account: M/S Shekhawati Derma Society

A/C No: 461401000051

IFSC Code: ICICI0004614

Bank Name: ICICI Bank

Branch: Rani Sati Road, Sikar

PAN No: ACAAS1903K

Payment Details

Total Payable: 0/- Rs.

Please send payment screenshot to cuticon23@gmail.com