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
Pincode
Conference Category
-- Select Conference Category --
For Physician — ₹ 12,500.00
For PG Students — ₹ 7,500.00
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 - Filler (₹ 8,000.00)
Hands on Workshop - Toxin / Neuromodulator (₹ 8,000.00)
Hands on Workshop - Exosomes for Skin and Hair (₹ 8,000.00)
Hands on Workshop - Threads (₹ 8,000.00)
Hands on Workshop - Peels (₹ 8,000.00)
Hands on Workshop - Skin Boosters - PDRN, Exosomes, PLLA, Peptides, Amino Acids (₹ 8,000.00)
Masterclass
-- Select an option --
Yes
No
Masterclasses
Masterclass with Live Demo - Periorbital Rejuvenation (₹ 5,000.00)
Masterclass on Regenerative Medicine (₹ 5,000.00)
Masterclass on Pigmentation (₹ 5,000.00
Masterclass on Practise Management (₹ 5,000.00)
*Conference registration is mandatory for workshop & masterclass registration
Registration Amount Paid: (In Words)
Registration Amount Paid: (In Numbers)
Attach Certificate / Letter from HOD
Accepted: PDF, JPG, PNG — Max 10 MB
Message
Pay & Submit Registration
