Online Registration

Registration Closed

Full Name(as required on the certificate)*

Don't add designation in your name

Email Id*

Mobile No.(whatsapp Number only without country code)*

Gender*

Country*

State*

City*

Address*

Institute*

Medical Council Registration Number*

Category*

Do you want to register Accompany? *

Do you want attend Workshop?

Upload Aaadhar Card*

Payment Mode*

Amount*

Bank Details:
Account Name: SZUSICON MANGALURU
Account No: 110247696480
IFSC Code: CNRB0008633
Bank Name: Canara Bank
Branch Name: : A J Hospital Extension Counter, Mangalore

UTR Id / Transaction Id.*

Transaction Date *

Upload Payment Receipt *