Register for Workshop

Title

First Name

Last Name

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Mobile No.

Phone No.

Designation

Institution/Hospital

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Pincode/Zipcode

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Payment Details(DD No./ Online RefID)

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Details

Registration Details

	Delegate	Student/Fellows
Upto 28/02/2019	Rs. 2000/-	Rs. 1000/-
Spot Regn.	Rs. 2500/-	Rs. 1500/-

^* Certificate from HOD required.
^**Cash payment only

Payment

Payment Details

Bank Transfer/ Demand Draft favouring "TERDU" (Trust for Education,Research and Development of Urology)
Payment Details
Account name:Trust for EDUCATION,RESEARCH & DEVELOPMENT OF UROLOGY,
Account number: 10413590610
Bank/Branch: SBI, Medical Institute, Sector 12, Chandigarh-160012
IFSC code- SBIN0001524