Online Registration

Registration Closed

Full Name(as required on the certificate)*

Email Id*

Mobile No.(whatsapp Number only without country code)*

Medical Council Registration Number*

Gender*

Meal preference*

Institute*

Address*

Country*

City

State*

Category*

Payment Mode*

Amount*

Bank Details:
Account Name: INTEGRATED BALANCE FORUM
Account No: 925020046779229
IFSC Code: UTIB0005025
Bank Name: AXIS BANK
Branch Name: AXIS BANK, CHINNAWALTAIR BRANCH VISAKHAPATNAM

UTR Id / Transaction Id.*

Transaction Date *

Upload Payment Receipt *

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