REGISTRATION FORM
IACTS Techno College 2019 Rohtak Haryana – NCR Delhi
Pt. B.D.S. University of Health Sciences, Rohtak
(25th- 26th May 2019)
Organizing Secretary
Prof S S Lohchab Head of Department Cardiac Surgery PGIMS, Rohtak , Haryana-NCR Delhi 124001.
Mob. No- 9416050122
Name (in Block letters) :
Designation /Highest Qualification :
Department :
Organization :
Mailing Address :
PIN : Telephone :
Mobile : Email :
Category :   Place :
REGISTRATION FEE : Free for All
Last Date of Registration 15-May-2019
Accommodation And Travel
Information about the availability of Hotel, Guest house and Hostel accommodations and travel reimbursement will be made available after registration.

Please indicate your preference of accommodation.
     
MCh & DNB Students have to submit authorization letter mentioning name, course and year from Head of Department for availing free travel (3 Tier AC Train Fair) & accommodation by email at ctcmetechnocollege2019@gmail.com


DECLARATION BY THE PARTICIPANT
The information furnished above is true to the best of my knowledge. I agree to abide by the rules and regulations governing the programme.

20-Apr-2019
Signature of Applicant


    Cancel