Online Application

2nd World Congress On Manual Therapy

(Online Registration Form)

Please Note that, No Registration will be made final before
full payment (DD) in favour of PHYSIOBD Health Informatics
Payable at Dhaka. Must be send to Address of Congress Secretariat of
Bangladesh or India. Please see Contact Us for Address.

 

Name:  Age:  Sex:  Category of Registration:Country/Present Location:  Qualification:  Blood Group:

Institute / Hospital:  Mobile No. With Country Code:

Email Address:

Mailing Address:


Will Join to Congress + 
Pre Congress Course 1 + 
Pre Congress Course 2 +
Post Congress Course 1 +
Post Congress Course 2

OR

Will Take Package option (Pre 2 + Congress + In Congress Workshop 1&2 + Post 2)

Payments:

Congress Registration Fees:
Pre/Post Congress Fees:
Accommodation Fees:
Grand Total:
DD Number:  Dated:  Bank+Branch:
Other Comments if Any: