Registration Form

REGISTRATION FORM

XV Annual Conference – 18^th-19^th January 2025

Hotel Radisson Blu Plaza, Mysore, India

Global Association of Physicians of Indian Origin (GAPIO)

Name*

Email ID *

Mobile No. (with country code)

Are you a member of GAPIO?

Yes

Fresh Medical Graduates or Residents – who have passed in 2024

Yes

GAPIO Membership Number (Applicable to Members only)

State Medical Council Registration No.*

Address*

City / Locality*

State *

Country*

Pin / Zip Code*

Mobile Number in India (For Foreign Delegates)

Note: Registration fee will remain same whether attending for one day or two days.

GAPIO Members	Non-Members(Includes Membership to GAPIO)	Accompanying persons of members or non-members	**Students (Includes Membership to GAPIO)	Dietetics / Physiotherapy Students
1000	2950	2950	1180	1000

**Medical Graduates or Residents – who have passed in 2024, and current DNB Trainees to enclose letter from HOD.

CONFERENCE SECRETARIAT:
Mr. Jitendra Malik
Global Association of Physicians of Indian Origin (GAPIO)
Hospital Complex, Indraprastha Apollo Hospital, Sarita Vihar, Mathura Road, New Delhi – 110076
Mobile: +91 – 8527849960 • Email: gapio_delhi@apollohospitals.com

Our Bank-details to Transfer Membership Fee – GAPIO Membership Program

(For remittance in India)		(For remittance from overseas)
Name of account	Global Association of Physicians of Indian Origin	Name of Beneficiary	Global Association of Physicians of Indian Origin
Name of Bank	Punjab National Bank (Earlier Oriental Bank of Commerce)	Name of Bank	Punjab National Bank (Earlier Oriental Bank of Commerce)
Name of Branch	Apollo Hospitals New Delhi India 110076	Name of Branch	Apollo Hospitals New Delhi India 110076
Account Number	50761131000189	Account Number	50761131000189
Type of Account	Current Account	Type of Account	Current Account
IFSC Code	PUNB0507610	Swift Code	PUNBINBBISB