Demo form

    autocomplete="both" autocomplete="off" autocomplete="both" autocomplete="off" autocomplete="both" autocomplete="off" autocomplete="both" autocomplete="off" autocomplete="both" autocomplete="off" autocomplete="both" autocomplete="off" autocomplete="both" autocomplete="off" autocomplete="both" autocomplete="off" autocomplete="both" autocomplete="off" autocomplete="both" autocomplete="off" autocomplete="both" autocomplete="off" autocomplete="both" autocomplete="off" autocomplete="both" autocomplete="off" autocomplete="both" autocomplete="off"

    Please read all the workshop related details given below and fill out the form accordingly.

    Topic: dry Cupping
    Duration: 1 Day
    Will be conducted by Dr. Jatin Patel
    BPT, MPT ( Rehab. )
    & his team.
    Venue: Blind People's Association ( BPA ) Vastrapur, Ahmedabad, Gujarat
    Workshop Date: 4th of June 2022, Saturday
    Last date for registration: 2nd of May 2022

    Workshop fees

    Registration fees Rs.1000/-
    Additional escort fees Rs. 500/-

    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





    Gender (required)

    Are you coming with escort? (required)

    Are you a registered IAVIP member? (required)


    Payment proof document must be clear. Max allowed file size is 500KBs and it must be in jpg, jpeg, png or pdf format.