Registration
Form
Medical Council Registration No.
Registration Received On
Full Name
Email Address
Mobile No.
Age
Gender
Male
Female
Designation
Organization / Hospital
Address
City
State
Country
India
Pincode
Conference Category
-- Select Conference Category --
For Physician — ₹ 12,500.00
For PG Students — ₹ 7,500.00
For Dermatologists — ₹ 12,500.00
For Plastic Surgeon — ₹ 12,500.00
Note: A Certificate/letter from the Head of Department (HOD) is mandatory to avail the PG student
Workshop
-- Select an option --
Yes
No
Workshops
Hands on Workshop - HA + CaHA (Only for Dermatologist and Plastic Surgeons) (₹ 8,000.00)
Skin 360 - Skin Booster (₹ 8,000.00)
Baby glow for skin boosters (₹ 8,000.00)
Polynucleotides plus exosomes (₹ 8,000.00)
Masterclass
-- Select an option --
Yes
No
Masterclasses
Masterclass on Pigmentation (₹ 5,000.00)
Masterclass on Practice Management (₹ 5,000.00)
Masterclass on Energy based devices (₹ 0.00)
*Conference registration is mandatory for workshop & masterclass registration
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Order Summary
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Inclusive of 18% GST
Attach Certificate / Letter from HOD
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Pay & Submit Registration
