3rd AMACON2025 Registration Form Billing details Full Name *S/O, W/O, D/O *Date of Birth *Contact Number *Email *Gender * Male Female OthersQualification *Correspondence Address *Place of Work *Medical Council Registration No *Brief about your Professional Work *Do you want to attend a Workshop? *NoWorkshop on Gastroenterology (+₹1,000.00)Workshop on Botox in Movement Disorder (+₹1,000.00)Critical care workshop (+₹1,000.00)Does your spouse want to attend the workshop? *NoWorkshop on Gastroenterology (+₹1,000.00)Workshop on Botox in Movement Disorder (+₹1,000.00)Critical care workshop (+₹1,000.00) Additional information Spouse Name * Spouse Qualification * Spouse Medical Council Registration No * Payment Summary Item Details Subtotal Couple Entry 3rd AMACON2025 × 1 ₹7,000.00 Subtotal ₹7,000.00 Total ₹7,000.00 Credit Card/Debit Card/NetBanking Pay securely by Credit or Debit card or Internet Banking through Razorpay. Since your browser does not support JavaScript, or it is disabled, please ensure you click the Update Totals button before placing your order. You may be charged more than the amount stated above if you fail to do so. Update totals Your personal data will be used to process your order, support your experience throughout this website, and for other purposes described in our privacy policy. Pay Now
