Registration Form – ANTC 2025

ANTC 2025

Full Name

Designation

Name of the institute

Mobile

Address for Communication: Address Line 1

City

Pin/Zip Code

State

Country

Name of Accompanying person

Registration Fees and Categories

SELECT	Category	Before 31^st Jan 2025	Before 28^th Feb 2025	31^st March 2025
1	8^th ANTC & Global Neuro Advanced Course-Neurotrauma (Delegate)	Rs. 5,900/-	Rs. 7,080/-	Rs. 8,260/-
2	8^th ANTC & Global Neuro Advanced Course-Neurotrauma (Resident)	Rs. 2,360/-	Rs. 2,360/-	Rs. 2,950/-

Bank Account Details:
A/C Name: AIIMS NEUROTRAUMA CONFERENCE
A/C No.: 43437078223
IFSC Code: SBIN0001536, Swift Code: SBININBB545
Bank Name: State Bank of India
Branch: (01536) Ansari Nagar, AIIMS, New Delhi-110029

Payment Details
Select mode of payment:

Cheque Number

Cheque Dated

Bank Name

Amount

DD Number

DD Date

Bank Name

Amount

Cash Amount

Transaction Number

Transaction Date

Bank Name

Amount

Transaction Number

Transaction Date

Bank Name

Amount

Note: Payment to be made by Cheque/Demand Draft in favor of AIIMS NEUROTRAUMA CONFERENCE. payable at New Delhi.

Signature

Date

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