Nepali Pre-conference

Nepali Pre-Con Registration Form

Prefix *

Mr. Ms. Mrs. Dr.

First Name *

Middle Name

Last Name *

Age *

Gender *

Address for communication *

City *

District *

Province *

Hospital / Institute

Designation

Email *

Mobile no *

Profession *

Category *

Payable Amount

Mode of Payment

Cash Bank Deposit Fone Pay

Bank Details
Bank Name: Rastriya Banijya Bank, Bhotahity, Kathmandu
Account Name: Speech & Hearing Association of Nepal
Account No: 1360100003059001

SCAN & PAY

SPEECH AND HEARING ASSOCIATION OF NEPAL
Bagmati Province, Kathmandu

Attach Payment/Transaction Receipt *

Please attach the transferred receipt/online receipt while submitting the registration form. The registration form without the payment/Transaction will not be accepted.
(Please enclose a copy of payment/transaction receipt obtained from your bank/ online receipt with the registration form. This is necessary to identify and confirm your payment)

CONFERENCE SECRETARIAT
Mr. Anil Kumar Adhikary
Speech & Hearing Association of Nepal
T.U. Teaching Hospital, Maharajgunj Medical Campus, Kathmandu, Nepal.
Ph: +9779819629555
Email: secretaryshannepal@gmail.com
For details, please check SHAN website: www.shan.org.np

Registration Team
WhatsApp No.
+9779860973222 (Neelam Lama)
+9779819629555 (Anil Kumar Adhikary)
Registration Email ID: registration@shan.org.np

Nepali Pre-Con Registration Form

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