Pre-Conference Workshop Registration Form

Title:

Prof. Dr.

Prof.

Dr.

Mr.

Mrs.

Ms.

Full Name: (As per govt. id/Passport/Aadhar Card)

Gender:

Male

Female

Other

E-Mail ID:

Mobile Phone:

Registration Category:

Membership No: (For ISHI Members)

Payment Mode:

Scan the QR Code to Pay:
QR Code for Payment

Bank Transfer Details:

Account Number: 44052080273

Account Name: ISHICON 2025

IFSC Code: SBIN0001524

SWIFT Code: SBININBB443

MICR Code: 160002007

Bank Name: State Bank of India

Branch: Medical Institute Branch, Sector-12, Chandigarh, India

Transaction Date:

Amount Paid:

Workshop Fee is INR 1,000 for all participants.

Payment Transaction ID:

Organization (Institute/Hospital /College Name):

Address:

City:

Country:

Workshop Registration and Fee Payment