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REGISTRATION FORM
6th ANNUAL CRITICAL CARE REFRESHER COURSE
17th, 18th, 19th 20th & 21st January, 2018
(Wed, Thu, Fri, Sat & Sun)

Name *
Designation *
Institute/Hospital *
Address*
City *
State *
Pin Code *
Mobile *
Email *
Total Paid Amount * INR 6500 /-
 
   Registration Cancellation Policy & Terms & Conditions
   [Note : Please check the registration cancellation policy & terms & conditions checkbox then enable submit button]
DD/Cheque to be drawn in favour of"Society of Critical Care Medicine – Delhi" and mailed to the address below.
For registrations kindly contact:
Dr Mozammil Shafi
Liver Transplant & Gastro ICU
ICU 9 & 10, 2nd Floor
Medanta – The Medicity
Sector- 38, Gurgaon
Haryana – 122001
Ph: +919599557808

Email: intensivecarecme@gmail.com