Full Name Gender MaleFemale Institute/Hospital Name Designation Address City State Pin Code Country Phone Number Mobile/Whatsaap Number Email ID Food Preference VegNon Veg REGISTRATION FEES —Please choose an option—Registration of JOAC Member (3000/-)Registration with accommodation for Single Sharing - 2 days (11000/-)Registration with accommodation for Double Sharing - 2 days (13000/-)Registration of PG Student (1500/-)Incidental Charge of Senior Citizen (above 65 Yrs.) (500/-) Accompany Person (Add On Service) 1500/- Per Head YesNO Total Accompany Person Accompanying Person (Above 8 Years) Optional 1. MaleFemale 2. MaleFemale 3. MaleFemale Total Amount Paid by You Payment Receipt (Transaction Details)
