Test Registration

Full Name

Address

Email

Mobile

Telephone

Designation

Hospital

Registration Category NEBAOI ₹8000 Non-NEBAOI ₹9000 Resident/PG Student ₹7000 Audiologists/Speech Therapists ₹8000 +70 years - Complimentary

Membership No

Associate Membership No

Type of Food Veg Non-Veg

Accompanying Person(s)

Number of Accompanying Person(s): 0

Name, Age & [Veg/Non-Veg] of Accompanying Person(s) [One per line]

Total Rate

Transaction ID [UPI/NEFT/RTGS]

Bonafide Certificate (for PG Students) - PDF/JPEG