Registration Form

Confluence 2026

Pharmacologist & Dermatologist on one platform

Workshop — Sat, 12 September 2026 · 9:00 AM – 1:30 PM
Conference — Sun, 13 September 2026 · 9:00 AM – 1:30 PM
Venue: Royal Treat, Marcela, Old Goa

Two Days, One Confluence

Day 1 · Sat 12 Sep

9:00 AM – 1:30 PM

Pre-Conference Workshop

Hands-on cutaneous adverse drug reactions
HLA pharmacogenomics & pharmacovigilance
Learn by real case files, not slides
Limited seats · certificate of completion

Day 2 · Sun 13 Sep

9:00 AM – 1:30 PM

National Conference

Pharmacology Sessions
Dermatology Sessions
Clinical view & drug mechanism, side by side
Keynote oration & live debate

On the Scientific Programme

Severe Drug ReactionsBiologics & Targeted TherapyTopical & Transdermal TherapeuticsRational Prescribing & PharmacogenomicsClinical Case ChallengeThe JAK-Inhibitor Debate

Paper & Poster Presentationse-paper & e-poster presentation

Registration Fees

Go Go Goa !!

EventEarly birdtill 31 Jul 2026Latetill 21 Aug 2026Spot

Workshop & Conference₹5000₹7000₹9000

One paper/poster included, then ₹1000 for each additional presentation.
₹2000 less for online delegate · ₹1000 less for IADVL life-member.
Offline registration includes entry, kit, scientific sessions, food & certificate.
Once registered, cannot be cancelled or transferred.
Only MD & PG doctors in Dermatology & Pharmacology, Cosmetologists & students may register.

Registration Form

Fill in the details below to register. Fields marked * are required.

Your details

Your name is printed on the certificate exactly as typed. Name and Surname are required.

Name *

Middle name / Initial

Surname *

WhatsApp number *

Email *

Designation *

Department / Clinic *

Institute / Private Practice *

City *

State *

Total Experience *

Payment

How to calculate your fee

Workshop & ConferenceEarly bird (till 31 Jul 2026) ₹5000 · Late (till 21 Aug 2026) ₹7000 · Spot ₹9000

Then adjust your total:

Minus ₹2000 if attending online
Minus ₹1000 if you are an IADVL life member
Plus ₹1000 for each additional e-paper / e-poster presentation (one included in registration)

Pick your final total in Total Amount Paid below, then pay by UPI or bank transfer.

Membership number (IADVL) [ if a life member — for the ₹1000 discount ]

Pay by UPI (scan the QR) or bank transfer, then enter your transaction details below.

Scan to pay · UPI

9898212104@ptsbi

Bank transfer

NameVISHAL A RAJPUT

A/C No03110108672

BankKalupur Commercial Co-operative Bank — Udhana

IFSCKCCB0UDN037

Note: both 0s in the IFSC (KCCB0UDN037) are the number zero, not the letter O.

Total Amount Paid *

Transaction Number / ID *

Registration received

Thank you. Your details have been recorded.

Confluence 2026 · Royal Treat, Marcela, Old Goa · drselinadermat@yahoo.com