Registration Details
DEPARTMENT OF ORTHODONTICS & DENTOFACIAL
ORTHOPAEDICS
SRI HASANAMBA DENTAL COLLEGE & HOSPITAL
Vidyanagar, Hassan, Karnataka.
“ORTHODONTIC ZONAL PG
CONVENTION”
20th 21st
& 22nd September 2019
REGISTRATION FORM
COLLEGE NAME WITH ADDRESS AND PHONE NO:
ATTENDEES WITH PHONE NUMBER (WHATSAPP):
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SL NO
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NAME
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EMAIL ID
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PHONE NO.
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Dental Council Reg no. (KSDC)
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IOS no.
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REGISTRATION DETAILS
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Till March 1st
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Till June 1st
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Till September 1st
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Spot registration
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4900
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5500
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6000
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6500
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7000
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Including food(breakfast, lunch, snacks and
tea all 3 days), Banquet and Trip
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PAYMENT
MODE: NEFT, Bank direct deposit or DD
Bank: Syndicate bank
Account name: Department of Orthodontics
A/C no: 14052200071923
Syndicate Bank: MCE Branch,
Hassan
IFSC code- SYNB0001405
All the DD’S should be sent
by registered post along with filled registration forms.
DD's should be taken in the
name of: Department of orthodontics,
payable at Hassan
Postal
Address:
DR BEENA DEVI
TREASURER,
ROOM No. 7
DEPARTMENT OF ORTHODONTICS AND DENTOFACIAL ORTHOPAEDICS,
SRI HASANAMBA DENTAL COLLEGE
VIDHYANAGAR, HASSAN-573202
After payment
send the transaction details to WhatsApp number 9544945132 or email it to hassanzonalpg@gmail.com.
If you need any assistance contact - Dr. Chetan S – 9986971863
Registration committee
Dr. Abiraj K. R –
9544945132
Dr. Fadhil
Mohammed – 7012356144
Dr. Mohammed
Ihjas - 7907246712
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