AMRITSAR CARDIOLOGY SUMMIT

Workshop 7^TH March Registration Form

Delegate Name Prof/Dr. *

Please provide a valid Delegate Name.

S/O, W/O, D/O *

Date of Birth

Sex *

Male

Female

Mobile No. *

Email *

Address *

Qualification *

Position *

Name of the Institute *

Institute Address & Contact No *

PMC Registration No *

Member of any Cardiac Association?

Yes

I agree that all above information given by me is correct.

AMRITSAR CARDIOLOGY SUMMIT | 2026