CCNA 2026

ONLINE REGISTRATION
Date: 8^th to 9^th Aug 2026

Full Name (as per Medical council) *

Email *

Whatsapp Mobile no (10 digits) *

State Medical Council No. *

Name of Clinic/Institute

Address

City *

State *

Pincode

Registration Category *

Category *

Workshop *

Accompanying Person *

note - If the number of accompanying persons is more than one, kindly contact the Event Team for further assistance 8956407238.

Accommodation Package *

Select Occcupancy

Select Room Type

Select Hotels

Accompanying Person Details

First Accompanying Person

FullName *

Email *

Phone *

Second Accompanying Person

FullName *

Email *

Phone *

Third Accompanying Person

FullName *

Email *

Phone *

Accompanying Person Amount

Delegate Residential Package Fees *

Accompanying Residential Package Fees *

Package Amount *

Workshop Amount *

GST Amount *

Total Amount *

Conference Amount:
Total Amount:

INR
Including of GST 18%

Payment Mode: *

I agree to receive registration confirmation via whats app and email..

PG
Certificate(only PG Student)

note - If the number of accompanying persons is more than one, kindly contact the Event Team for further assistance 8956407238.

Accompanying Person Details

First Accompanying Person

Second Accompanying Person

Third Accompanying Person

Conference Amount:

Total Amount: