IAPCON

Register


Direct Fund Transfer

Once the payment has been made, please complete the registration form below to register. This form is meant for those who transfer the payment online. If you wish to register more than two individuals and make one common payment please download the Group Registration form fill in all the details and email it as an attachment to register@iapcon2017cbe.com. The Group Registration Form is in Microsoft Word format. If you are unable to use it please download the PDF version and submit all the information required.


Cheque or DD

Alternatively you can draw a cheque or DD in favour of IAPCON COIMBATORE 2017 payable at Coimbatore and send it with completed individual registration form to the given below address. The individual Registration form is in Microsoft Word format. If you are unable to use it please download the PDF version and submit all the required information required. An email with the registration number will be sent to you once the cheque or DD has been realized.

IAPCON 2017, VN Cancer Centre,
P.N.Palayam, Coimbatore - 641037.
Tamil Nadu, INDIA
Tel: +91 99444 08049 / +91 96776 66160.
Email: register@iapcon2017cbe.com


Registration


Are you an IAPC member? 

Yes No

Delegate Category 


PERSONAL INFORMATION


Title 


Country 


PAYMENT DETAILS

Please fill the following fields after you transfer the payment.
Registration can be confirmed only after we realize the payment.

* Once the form is submitted you will receive an acknowledgement email initially. Once the payment is realised, a further confirmation email will be sent along with your registration number. Kindly refer to your registration number for all future correspondence.