Workshop Registration-T1DM

DEBATE 2020 - WORKSHOP REGISTRATION FORM

Name (as it should appear on the delegate badge)

Address

Mobile

Email

Age

Accompanying Parent Name

DEBATE-2020
175, Brahmaputra Street,
Palaniappa Nagar, Valasaravakkam,
Chennai – 600087
Tel: +91 44 24862822
primerconference@gmail.com
www.primercme.com

C/o CDEC, 410/A, 1st Stage,
3rd Block, Near BDA Complex,
HBR Layour, Kalyannagar Post,
Bengaluru – 560043
Tel: +91 80 25440011/25440055