CHOLESTEATOMA 2018

Step 1: Personal Details

* are Mandatory fields

Please fill in the below details to register. Please note that your registration will not be complete until you finish all the steps.

Full Name * (Same would be printed on Certificate)	Enter Your Full Name

Medical Council Name *	Enter Medical Council Name

Medical Council Number *	Enter Your Medical Council Number

Organisation / Hospital

Designation

Contact Details

Email *	Enter your Valid Email id

Residence Telephone
Office Telephone

Mobile*	Enter your Valid Mobile number

Fax

Address 1*	Enter your Address

Address 2

City*	Enter your City Name

State

Country	Enter your Country

Pincode/Zipcode*	Enter your Pincode/Zipcode

Food Preference

Food Preference*	Vegetarian Non-Vegetarian Please select Food Preference

Click to proceed to the next step

Payment : Cheque/DD - Online transfer (RTGS / NEFT) - Cash

* are Mandatory fields

Name on the Cheque / DD	ARCHIS CONTROL SYSTEMS
Address to send the Cheque / DD	AVYAYA MEDICON Cholesteatoma Response Cell 260, 1st Floor, 44th Cross, Jayanagar 5th Block, Bangalore 560041. Phone: +91-80-6535-5535 / 9108790781

Account number	376301010036673
Bank	Union Bank Of India
Branch	Chowdeshwari temple street, Bangalore 560002.
RTGS / NEFT IFSC code	UBIN0537632
MICR Code	560026012

Cheque / DD No *	Enter your Cheque / DD No
Cheque / DD Dated *	Enter your Cheque date

NOTE
Online Transfer:
NEFT/RTGS/IMPS (Please mention participant’s name in the remarks during registration payment process)

Bank Name *

Branch *	Enter Bank Branch
RTGS / NEFT transaction code *	Enter RTGS / NEFT transaction code

Amount *

(Clicking on the above link will complete your registration. By clicking on the finish button, you agree to all the conference terms and conditions mentioned above as well as in the material rights page.)

CATEGORY	Early Bird (Valid up to 15th December 2017)	Regular (From December 16th 2017 to March 8th 2018)	Spot
Consultant	Rs 7700/-	Rs 8850/-	Rs 10000/-
PG Student	Rs 3500/-	Rs 4000/-	Rs 4500/-
Foreign Delegate	$450	$450	$500
Foreign Residents	$240	$240	$240

CATEGORY	Early Bird (Valid up to 15th December 2017)	Regular (Valid From December 16th2017 to March 8th 2018)	Spot
Consultants	Rs.7700/-	Rs 8850/-	Rs 10000/-
PG Student	Rs 3500/-	Rs 4000/-	Rs 4500/-
Foreign Delegate	$ 450	$ 450	$ 500
Foreign Residents	$ 240	$ 240	$ 240
Click to choose your mode of payment

Cholesteatoma 2018
From: 9th to 11th March 2018
www.cholesteatoma.in

ONLINE REGISTRATION

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Registration Packages:

Terms and conditions

Account Details:

Conference Response Centre