Online Registration Portal

Personal Details
Please enter your full name.
Please select your Designation.
Please enter a valid email address.
Please select your gender.
Please enter a valid 10-digit Mobile number.
Please enter a valid 10-digit Mobile number.
Conference Details
Please select your Category.
Please enter your Institution Name
Please enter your Highest Degree
If not applicable, please enter NA.
Please enter your Medical Council Name
If not applicable, please enter NA.
Please enter your Medical Council Number
Please select your food preference.
Please select how you are attending the conference.
Only the first 40 participants are allowed. Seats left: 0
Additional Details
Please select Yes or No.
Please select Yes or No.
Maximum 500 characters. 500 remaining.
Payment Details
UPI QR Code

Account Details

Account No: 50250000097415

Name: KAIRALI ASSOCIATION OF PREVENTIVE AND SOCIAL MEDICINE

IFSC: ESMF0001690

Bank: ESAF BANK MEDICAL COLLEGE BRANCH

Amount Split-up

Registration Fee:0

Accompanying Person Amount:0

Workshop Amount:0

Total Amount:0

Please enter your Transaction ID.
Allowed file types: JPG, JPEG, PNG, PDF. Maximum size 5MB.
Please upload your proof of transaction.