Registration Form
Full Name
Email
Phone (Preferably WhatsApp number)
Designation
Hospital
Address
Are you a member of ASI?
Yes
No
Are you a member of NECASI?
Yes
No
Type Of Food
Veg
Non-Veg
Registration Category
Choose Category
1 - Delegates - ₹ 2360
2 - Junior Resident Doctors (Academic / Non-Academic) - ₹ 1180
No of Accompanying Person(s)
No of Accompanying Persons:
0
@
1770
per person.
Name, Age & [Veg/Non-Veg] of Accompanying Person(s) [One per line]
Total Rate
Submit
