
REGISTRATION FORM
Name :
NMC / State Medical Council No.:
FOGSI Life Member. Date of Birth_______________________
Clinic / Institutional Address :
City : State : Pin :
Whatsapp / Mobile No.: E-mail:
Are you submitting Abstract/ Paper/ Poster?:______________________________________________________________
Please ind enclosed herewith Cheque No. Dated.
Name of the Bank :
For Rs.
DD/Chequetobemadeinfavourof"FogsiPresidentialConference2025"
Online Payment details: UTR / UPI No.____________________________________________________
Date & Time :
Scan & Pay
BankDetails:
FOGSI Member. Non Member.
RegistrationGuidelines:
ŸRegistration is mandatory for attending the conference.
ŸConference registration is mandatory for Paper, Poster Presentation, Quiz Competition and
ŸNational Public Forum Participation Certiicate.
ŸConference registration fee include admission to scientiic halls, trade exhibition, inaugural function lunch,
inaugural dinner (date to mention) and delegate kits.
ŸOrganising committee shall not be liable in any form in case of change in date/venue due to unforeseen
reasons.
Cancellation & Refund:
1. All Cancellation should be made in writing and sent to Conference Secretariat by 31 Aug 2025
to avail 50 % refund of the registration fee after deduction of GST.
2. The refund process will begin only after 30 days of the completion of conference.
3. No refund will be done if cancellation of registration is done after 31 Aug 2025
CONFERENCESECRETARIAT
Dr.MeeraAgnihotri
OrganizingChairperson
Mobile:+91-9838004050
7/199,RCAgnihotriCrossing,JeevaniHospital,
SwaroopNagar,Kanpur
Email-fogsipresidientialconference@gmail.com
Dr.NeelamMishra
Org.Secretary
Mobile:+91-9936102444
Dr.KalpanaDixit
OrganizingSecretary,
President, KOGS
Mobile:+91-9838202087,
www.fogsipresidentialconference2025.com
Registration Details (TICK APPLICABLE)
TillDate EarlyBirdTill
st th
1 Juneto30 June-25
Fogsi Members
Non Member Fogsi
@ 7,000/- @8,000/-
@ 8,000/- @ 9,000/-
OnSpot
@ 10,000/-
@ 11,000/-
KitBagSubject
toavailibilty
RegularTill
st st
1 Julyto31 July-25
@ 9,000/-
Residents-PG @ 5,000/- @ 6,000/- @ 8,000/-
@ 7,000/-
@ 10,000/-
UPToTill
st st
1 Augto31 Aug-25
FOGSI NATIONAL PRESIDENTIAL CONFERENCE 2025
Hosted By: KANPUR Obstetrics and Gynaecology Society
th th
12 -14 September 2025, Kanpur (Uttar Pradesh)
Bank Name - SBIBranch - Medical College
ACC Name - FogsiNationalPresidentialConference
Account type - Current
Account ACC no - 44174127067
IFSC code - SBIN0003076
MICR code - 208002050
Click here to Register!
Accompanying Person @ 6,000/- @ 6,000/- @ 6,000/-
@ 6,000/-