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  • SCOPE Registration Form

    Uploaded by

    Monirah Zeya
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    The document is a registration form for the SCOPE course taking place virtually from September 1-5, 2021. It includes fields for the participant's name, age, email, mobile number, hospital, academic years, and willingness to present a case. It provides online payment details and instructions to email the completed form and transaction details to delhistatechapter@gmail.com.

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    The document is a registration form for the SCOPE course taking place virtually from September 1-5, 2021. It includes fields for the participant's name, age, email, mobile number, hospital, academic years, and willingness to present a case. It provides online payment details and instructions to email the completed form and transaction details to delhistatechapter@gmail.com.

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    7 views1 page

    SCOPE Registration Form

    Uploaded by

    Monirah Zeya
    The document is a registration form for the SCOPE course taking place virtually from September 1-5, 2021. It includes fields for the participant's name, age, email, mobile number, hospital, academic years, and willingness to present a case. It provides online payment details and instructions to email the completed form and transaction details to delhistatechapter@gmail.com.

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    © All Rights Reserved
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    of 1

    SCOPE COURSE- 2021 (Virtual)

    Surgery Clinical Oriented Postgraduate Examination Course


    1st to 5th September 2021
    REGISTRATION FORM

    1. Dr. Monirah Zeya


    Name: ………………………………………………………………………. Age /Sex: ……………………………………………….
    26yrs/Female

    2. Email: ………………………………………………………………………
    monirahzeya@gmail.com Mobile: ..………………………………………………….
    838408466

    3. UCMS and GTB hospital


    Hospital: ……………………………………………………………….… 2019-2022
    Academic year: ……..………………………………

    4. Name of Guide/Supervisor (Optional): …………………………………………………………………………………………………

    5. Willingness to present Case : Yes Yes / No

    FORM also available at : https://asidelhi.com/scope.html

    Payment Details:
     Rs.600 – till 15th August 2021.
     Rs.1000/- after 15th August 2021 and for On-spot registration if seats are available.

    Online Payment (through RTGS / NEFT) Details


     Link to online payment: http://www.asidelhi.com/scope.html

     Online Payment (through RTGS / NEFT)


     Account name - Association of Surgeons of India, Delhi,
     Bank name - Canara bank, Branch: Gangaram hospital, Delhi
     A/c No -90682010022426, IFSC Code CNRB0019111, Account type- Saving

    ----------------------------------------------------------------------------------------------------------------------------- ----------------

    Kindly mail the registration form with transaction details at delhistatechapter@gmail.com


    For further queries: Mob: 9811743877, 9810396769

    Date 31/7/21 Signature of candidate

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