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CONFERENCE ONLINE REGISTRATION

CONTACT +91 98660 44298 FOR REGISTRATION SUPPORT

Registration Type*

UG Student PG Student Delegate

Personal Details

Title*

Prof. Dr. Ms. Miss Mrs. Mr.

First Name* Middle Name Last Name* Note : Name as required on the Certificate

Gender*

Male Female

Designation Hospital/Organisation* Address for correspondence* City* Mobile Number* WhatsApp Number* Email Address* State Dental Council Number Upload Passport Size Photograph* Note: Only PNG, JPG, JPEG, BMP, and GIF formats are allowed. Maximum file size: 5MB

Conference Preferences

Food Preference*

Veg Non Veg

Select Pre-conference Courses (Maximum 2) Registered candidates can attend any 2 pre-conferences – free of cost

You can select maximum 2 courses.

Accompanying Person Details

Please note that charges will be applicable for accompanying persons, and the same shall be advised soon.

Total Accompanying Individuals*

None 1 2 3

Number of Adults Number of Children

The total number of adults and children must equal the number of accompanying individuals selected.

Accompanying Person 1

Accompanying Person 2

Accompanying Person 3

Payment Details

Mode of Payment*

Bank Transfer UPI

Account Details

Account Name: Sree Balaji Dental College and Hospital
Account Number: 4921000100015252
Bank: Punjab National Bank
IFSC: PUNB0492100

Transaction Details

Total Amount* UTR Number/Transaction ID* Date Of Transaction* Upload Payment Confirmation Screenshot* Note: Only PNG, JPG, JPEG, BMP, GIF, and PDF formats are allowed. Maximum file size: 5MB

Any other Special Request :

By clicking the submit button, I hereby confirm and agree that the registration, once completed, is final, non-cancellable, and non-rescindable. I acknowledge that all payments made towards the registration are non-refundable.

Conference Secretariat:

The Organising Secretary
Sree Balaji Dental College and Hospital
Velachery Main Road, Narayanapuram,
Pallikaranai, Chennai 600 100

Email: secretariat@isdr2026.com
Website: www.isdr2026.com