Demo form Please read all the workshop related details given below and fill out the form accordingly. Topics Certificate Course in IASTM Practitioner ™️ ( Instrument Assisted Soft Tissue Mobilization ) Certificate Course in Spine Manual Therapy Practitioner ™️ Duration: 3 Days Will be conducted by Dr. Jatin Patel BPT, MPT ( Rehab. ) Venue: Shivarimal, near Saputara, District Daang, GUJARAT Workshop Dates: 16th, 17th and 18th of September 2022, Friday to Sunday Last date for registration: 25th of August 2022 Workshop fees Registration fees Rs.1600/- Additional escort fees Rs. 600/- Instructions Please read and fill all the form fields carefully. All the form fields marked with * or indicated by the word required are mandatory. In addition to your personal details, You will be asked to upload your payment proof document so make sure that you pay registration fees mentioned above before filling the form. Account details are given below for your reference. Account details Name of bank: Union bank of india Name of account: indian association of visually impaired physiotherapist Account Number: 312802010043103 IFSC code: UBIN0542237 If you have any questions regarding registration or having difficulties in filling this registration form, You can contact our registration committee. Contact details are given below. Niranjan Vala +91 97125 80724 Mahesh Sodha +91 70161 06343 Saurav Patel +91 70430 25872 Mittal Panchal +91 70161 19779 First name (required) Last name (required) Email (required) Contact number (required) Gender (required) MaleFemaleOther Are you coming with escort? (required) YesNo Are you a registered IAVIP member? (required) YesNo Payment proof (required) Payment proof document must be clear. Max allowed file size is 500KBs and it must be in jpg, jpeg, png or pdf format.
