IFNRCON2021

Registration Form

Title *

First Name *

Last Name *

Gender *

Date of Birth *

Qualification *

Designation *

Category *

Upload letter from HOD/College Id (only pdf) *

Choose file

Clinic / Hospital *

City *

State *

Postal Code *

Country *

Mobile No. *

Alternate Contact No.

Email id. *

Alternate Email id.

Register for WFNR/ IFNR Neuro Rehab Course

Registration for IFNRCON 2021

Are you IFNR Member *

Yes

No

Payable Amount :

PAY ONLINE (using Credit / Debit Card or NEFT)