JSRC 2025 registration Form

June 29th, 2025, Sunday
JSRC 2025

22nd Annual conference of IRIA Jharkhand state Chapter

RIMS Ranchi

(After filling up this form please send your payment Proof whatsapp no. 7721980009)
Delegate Name*

First NameLast Name
E-mail*
Phone Number*

Area CodeMobile Number
Specialization *
Highest qualification
IRIA Member*
IRIA FOLIO no.
Number of accompany people attending*
Accompanying Person
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Expected presence

Gala dinner 28th juneMain conference 29th June
Preferred diet

Non vegVeg
Abstract title
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Mode of payment

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