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 Tree, Goa

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 21 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