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Registration Form

*Name :
*Designation :
*Date:
*E-mail :
*Phone Number :
Alternate Phone Number :
*Department :
*Name Of Institute :
*Address :
*City :
*Pin Code :
MC Registration Number :

*Are You member of IAPSM ? :
Yes     No
*Are you member of IPHA ? :
Yes     No


Payment










*Payment For :
Only Conference
Only Pre-Conference Workshop
Pre-Conference Workshop + Conference
*Payment Transaction Id :
*Upload Payment Slip :
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*Food Preference :
Vegetarian
Non-Vegetarian