· web viewifsc code: tjsb0000025 micr code:411109018 email id transaction id and other...
TRANSCRIPT
DELEGATE REGISTRATION FORM
Please E-mail your Completed Registration form along with Remittance of Registration Payment to [email protected]
Please complete the form in MS Word (One form per delegate)
Title: Prof./Dr./Ms./Mrs./Mr.
Last Name/Family Name First Name and middle name (In full)
Department
Institution Name
Postal Address
City State
Mobile
Email Address
MMC/MCI Reg. No.
PAYMENT DETAILS
Option 1: Bank Transfer (NEFT) Name of the Bank: TJSB Sahakari Bank Ltd. Acc.No:025120100000024. Branch: Narhe,Pune411041
Account name: Smt. Kashibai Navale Medical College & General Hospital
Account type: Current
IFSC Code: TJSB0000025
MICR Code:411109018
Email id Transaction ID and other details to: [email protected].
Final date for Bank Transfer payments will be 15th April 2016
Transaction ID.
Option 2: Demand Draft in the favour of Smt. Kashibai Navale Medical College & General Hospital
Acc.No:025120100000024.
Demand Draft No. Name of the bank and branch:
Amount: 800INR (Faculty)/500INR(PG)
Option 3: Cash 800INR (Faculty)/500INR(PG)
Signature