XIX National PG Convention, 2021
REGISTRATION FORM
BEFORE DOING THE REGISTRATION PLEASE COMPLETE THE PAYMENT PROCEDURE & NOTE TRANSACTION DETAILS
Full Name
*
Gender
*
DCI Registration No.
Name of the College
*
Postal Address
*
Mobile No. (Whatsapp No.):
*
E-mail :
*
IAOMP No. :
Member Delegate :
Student Delegate:
Total Amount Paid:
*
Payment Mode:
*
Cash
Neft
RTGS
UPI Payments
Transaction Details with date:
*
Submit
BANK DETAILS
Bank Name : FEDERAL BANK, MAIN ROAD, RAJAHMUNDRY, AP.
Account number : 13410200005912
IFSC Code : FDRL0001341