REGISTRATION FORM

FOGSI Membership No.:

Title:
Prof Dr Mr Ms Mrs

Age:

First Name:

Middle Name:

Last Name:

Gender: Male Female

Address:

City:

State:

Pin:

Phone:

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Accompanying Person, if Any:

All the above fields are mandatory

Pre-Conference Workshops - 07th September 2024

Aesthetic Gynecology

Colposcopy

Hysteroscopy

Infertility

Category	Early Bird Reg. Till 31st July	Regular Reg. from 1st Aug to 31st Aug	From 1st Sept till on the spot
Workshop Fees	INR 2500	INR 3000	INR 3500
Faculty / Delegate (Only Conference)	INR 7000	INR 8000	INR 9000
All Inclusive (Faculty / Delegate) Workshop + Conference + Banquet (7th Sept)	INR 12000	INR 14000	INR 16000
PG STUDENT	INR 5000	INR 6000	INR 7000
ACCOMPANYING PERSON	INR 5000	INR 6000	INR 7000
PAID BANQUET (7th Sept)	INR 2500	INR 3000	INR 3500

Note - PG Students have to Submit Bonafied Certificate from HOD.
Conference Registration is mandatory for Pre-Conference Workshops.

Inclusive of 18% GST

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I am enclosing herewith a cheque / Demand Draft / RTGS (UTR Number)

Date

of Rs. (in words)

Only Drawn on Bank

Payable at Ghaziabad

Second Date

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