Registration Form

Registration Closed

Full Name(as required on the certificate)*

Email Id*

Mobile Numner(without country code)*

Medical Council Registration Number(MCI)*

Gender

Institute/Hospital

Address

Country*

City

State*

Category*

Do you want to register Accompany? *

Do you want attend Workshop? *

Payment Mode*

Amount*

Bank Details:
Account Name: National Conference of Pediatrics Education
Account No: 094894600000364
IFSC Code: YESB0000948
Bank Name: YES Bank
Branch Name: Eluru Road,Vijayawada

UTR Id / Transaction Id.*

Transaction Date *

Upload Payment Receipt *

Drag & drop your receipt here

or click to select a file (PDF, JPG, PNG)