Napticon 2024 registration form – PRISM EVENTS NAGPUR

REGISTRATION FORM

Blank Form (#5)

Type of Delegates

PG Students (NPT Members) (Rs-1)

Price: ₹1.00

PG Students (Non - NPT Members) (Rs-5500

Price: ₹5,684.00

Faculty (NPT Members) (Rs-5500)

Price: ₹5,584.00

Faculty (Non-NPT Members) (Rs-6000)

Price: ₹6,201.00

Enter Detail Membership No./Registered EMail/Registered Mobile

Personal Details

Prefix

Print Name on Certificate Badge (Don't write Dr./ Prof./ Mr./ Mrs.)

Date of Birth* (DD/MM/YYYY)

Mobile Number

Full Name

Gender

Current Working Details

Current Designation

Address of Current Institution/ Organisation/ Company

City

Name of Current Institution/ Organisation/ Company

State

Pincode

Academic Qualification Details

Qualification (Only qualifications recognized by NMC / MCI)

Registration No

Name oF Regulatory Body (MBBS / MD Registration Detail)

Date of Registration* (DD/MM/YYYY)

Workshop Details

Workshop Type* (Are you willing for any workshop?)

Yes

Pre-confrence Workshop

Workshop-1 Techniques in Scientific writing with hands on training using Artificial Intelligence tools (Rs-2000)

Workshop-II Basics in Biostatistics with hands on training using Artificial Intelligence tools (Rs- 2000)

Accompanying Person Details

No. of Accompanying Person

Payment Item

1- (Rs-3000)

2- (Rs- 6000)

3- (Rs- 9000)

*Note:- Internet handling charges Extra

All the information given herewith by me is true to the best of my knowledge and
in case of any discrepancies, I will be liable to actions as per the rules of
association. I will abide by the rules and regulations of national association
of pharmacology and therapeutics.