REGISTRATION DETAILS

Delegate Category Registration amount** (Including 14% Service Tax) Pay Online
Jr Residents or Post Graduate Students INR 5000 Book Online
Non-PG Doctors – Consultants INR 6000 Book Online
** Please add INR 80 for outstation cheques

light_blue_tick_icon There are limited 60 seats only. Delegate enrolment will be strictly on first-cum-first basis.

light_blue_tick_icon Post Graduate students need to attach a proof of residency forwarded by their Department or Program Head.

Payment & Payment Options (The amount mentioned above includes Service Tax)

bulletBy Cash

bulletBy Cheque #

bulletBy Bank Transfer ##

bulletOnline transfer (through website www.dermasourceindia.com)

# Address for posting cheque with completed Registration form :
THE SOURCE, C-2246 (Basement & Ground floor), Sushant Lok -1, “Suhridaya”, Block-C, Opposite Chiranjiv Park, Near Gold Souk Mall.
Gurgaon-122009, Haryana, India.
## Bank Transfer details:
Beneficiary Name: THE SOURCE
Bank Name: HDFC Bank Ltd.
Branch: The Peach Tree, C-Block, Sushant Lok-1
Account Number: 26862320000062
Type of Account: Current
IFSC Code: HDFC0002686