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On Integrated Approach to Airway Diseases Venue: The Empress Hall, Fairfield by Marriott, Kolkata, CB 218, CB Block B, Action Area 1C, Newtown, Kolkata - 7000156
Date: 28th May 2023 Name : Age : Sex : MaleFemaleOthers Phone Number : Email : Address : City : State : Pin : Country : Institute / Hospital : PGTNON-PGT
I hereby enclosed cheque / demand draft / Cash / money transfer through net banking no. Date Drawn on in favour of “Institute of Pulmocare & Research”.
Signature : Date :
Registration till 20th May 2023: PGT: Rs. 1500/- Non PGT: Rs. 2500/-
Spot registration: PGT: Rs. 2500/- Non PGT: Rs. 3500/-
Name of the Account: Institute of Pulmocare & Research Bank Name & Branch: State Bank of India, CF Block, Salt Lake, Kolkata 700 064 Account Number: 31344713421 IFSC: SBIN0012360 PAN Card No: AAAAI0592E
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