The 7th Annual Parekh Indo –US Foot and Ankle Conference. 8, 9, 10 January2016
Registration Form: INDO-US FOOT AND ANKLE COURSE 2016, Ahmedabad
Select Registration Type
Physiotherapist(only for Saturday)
3) What way you want print on badge:
4) Address / Landmark for correspondence:
9) Mobile No:
11) Repeat Email address:
12) A. Alternate email address:
B. Have you submitted abstract online for e Poster?
13) A. Are you a Gujarat Orthopaedic Association member?
B. Are you an Indian Orthopaedic Association Member?
14) Are you a PG Student or Resident?– upload Image file of Certificate from HOD.
15) Mode of Payment done: (tick and fill anyone from A to D):
(1) Beneficiary Account Name:
‘Indo-Us Foot and Ankle Course 2016 ‘
(2) Beneficiary Account Number at State bank of India:
(3) Beneficiary Account IFSC:
A .Cash at State Bank of India at any Branch filling beneficiary details.- Upload ( by clicking choose file button just above submit button) scan/photo of stamped pay in slip.
B. Cheque or Draft deposited at State bank of India at any Branch filling beneficiary details. Upload (by clicking choose file button just above submit button)scan/photo /image of stamped pay in slip
C. NFT/ RTGS – online fund Transfer from State Bank of India or any other bank (use above account number and IFSC code of beneficiary ). Note online transaction ID and paste that id in enter input button just above submit button
D. Mobile fund Transfer ( IMPS) : online fund Transfer from State Bank of India or any other bank by your mobile phone (use above account number and IFSC code of beneficiary).Note online transaction ID and paste that id in enter input button just above submit button
Note:- Allowed file Types[".jpg,.png,.gif,.jpeg,.pdf"]