Registration Form for Training - Hands on training...

(Gynaecolosist of all countries can register)

*Please fill in all the fields

First Name(*):
Last Name(*):
Gender(*):
Your Age:
Qualification(*):
Are you a member of FOGSI:
Address:
Telephone Nos
Mobile Nos
Your Email(*):
Intrested to join Course From date:
To date:
Comments:
Fee payment details (In case you have already Paid):

Fee Payment Options

For Applicant from India
  1. Deposit the amount in ICICI Bank account no. 063701500526 ,Name of the Account :Ramkrishna Purohit. And send us the relevant transaction details.
  2. Send us a account payee demand draft favouring Ramkrishna Purohit payble at Bargarh,Orissa.Please dont forget to mention your details on the back of the demand draft.Our postal address is mentioned in the Contact page
For Applicant from other countries
  • Bank transfer the amount using the following details :
  • Name of the bank : ICICI Bank Ltd , Nariman Point , Mumbai.
  • Beneficiary Account No. : 063701500526.
  • Beneficiary : Ramkrishna Purohit.
  • SWIFT/BIC Code : ICICIBBXXX.