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PHONE NUMBER :
+91 9922 050 131
EMAIL ADDRESS :
masicon2025@gmail.com
Venue Location :
Hotel Sayaji Kolhapur
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PHONE NUMBER :
+91 9922 050 131
EMAIL ADDRESS :
masicon2025@gmail.com
Venue Location :
Hotel Sayaji Kolhapur
Registration Form
Registration Type
*
Non-Residential
Residential
Registration as:
*
ASI Member
( ₹12500/-)
Non ASI Member
( ₹13500/-)
PG Student
( ₹8500/-)
Salutation*
Dr.
Prof.
Full Name
*
Gender
Male
Female
WhatsApp number
*
Email
*
Address
*
ASI Number
*
Institute /Hospital Name
*
Select State
*
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Assam
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Chhattisgarh
Goa
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City
*
Pin Code
*
Medical Council Registration Number
*
Do You Have Accompanying Person
*
No
I have 1 Accompanying person
I have 2 Accompanying persons
I have 3 Accompanying persons
Fullname of accompanying person (1)
Fullname of accompanying person (2)
Fullname of accompanying person (3)
Residential Package
Single
Twin Sharing
Package
*
3 night 4 days
4 night 5 days
Hotel Category
*
Hotel Deluxe
Hotel Premium
Hotel Luxury
Select Check In Date
*
05-02-2025
06-02-2025
07-02-2025
08-02-2025
09-02-2025
Select Check Out Date
06-02-2025
07-02-2025
08-02-2025
09-02-2025
*Total amount includes Registration charges + accommodation charges
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