Ayush Society | Workshop Registration

Please fill this registration form only after you have made the payment for the Workshop Program. Thank you in Advance.

* Required field

Name *

Father's Name *

Email *

Address *

Phone No *

Gender *

Category *

Whether PWD ( if yes, type of disability)

Institutional Affiliation (If any) *

Professional Status (Designation) If any *

Rehabilitation Qualification ( If any) *

Area of Specialization *

Year of Registration (If any) *

Registration Fees - Rs. 500/- | (Upto 30/04/2022) *

Mode of Payment *

Payment Reference No *

BANK NAME *