APPLICATION FORM FOR CONFERENCE CME FEES - IAP INTENSIVE CARE CHAPTER

(Venue City)

(Venue State)

Conference/CME From Date

Conference/CME To Date

Days of Conference

Pharma Sponsored

Name of Organising Secretary

Select Type of conference :(Applicable for all online/offline/Hybrid programs)

Non-Pharma Sponsored Programs (Workshops/CMEs/Masterclass)

Fees

Pharma Sponsored Programs (state/zonal CMEs/Conferences)

Fees

One Day
One Day
Two Day
Two Day
Three Day
Three Day
for correspondence
Dr. Sachin Shah
Secretary, IAP Intensive Care Chapter,
S.No. 8,
Surya Mother and Child Superspeciality Hospital,
Near Hinjewadi Flyover, Wakad, PUNE, 411057,
Maharashtra, India
secretary@piccindia.com
98505 66196 ​