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Registration Form

This document contains a registration form for the 6th Annual Cardiac CME taking place on July 29th-30th 2017 in Bhopal. The form includes details about the attendee - name, age, gender, address, contact information, year of residency, institution and teacher's name. It also notes the attendee's arrival and departure dates as July 28th and 30th respectively. The form requests the attendee bring surgical loupes and a valid identity card to the event.

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vamshidh
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84 views1 page

Registration Form

This document contains a registration form for the 6th Annual Cardiac CME taking place on July 29th-30th 2017 in Bhopal. The form includes details about the attendee - name, age, gender, address, contact information, year of residency, institution and teacher's name. It also notes the attendee's arrival and departure dates as July 28th and 30th respectively. The form requests the attendee bring surgical loupes and a valid identity card to the event.

Uploaded by

vamshidh
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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VIth Annual Cardiac CME

29th& 30th July 2017


Dr V. M. Kanhere Dr Nikhil Pendse
Organizing Chairman Organizing Secretary

REGISTRATION FORM FOR THE CME

Name- T VAMSHIDHAR

Age- 29 Male/Female-MALE

Address- FLAT 405, Arun residency, reddy colony


Bairamalguda, hyderabad 500079

Phone number- 9849465014

Residency (M.Ch/DNB) year going on- 3rd year

Name of the college/institution- CARE HOSPITALS, BANJARA


HILLS

P.G teacher’s name- DR G RAMASUBRAMANYAM

Date of arrival in Bhopal- 28th JULY

Date of departure from Bhopal- 30th JULY

Note- Please bring your surgical loupes along with you and an identity
card, i.e, Adhaar card/ Driving Licence/ Voter id/ Passport/PAN card.

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