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Note : Please make sure that the first, middle and last name filled in the registration are the same as you would like to be displayed on your eCertificate of Participation (eCoP).

* fields are mandatory

Account and Personal Details

First Name *

Middle Name

Last Name

Mobile Number *

Email *

Note: Continue by filling up below remaining details and complete registration by clicking on the "Register" option at the bottom.

Create Password *

Confirm Password *

Address

Current Affiliations *

Gender * Male Female Non-Binary

Address Type *
Personal Official

Address *

Zip Code *

Country *

State *

City *

Registration Choices

State Medical Council Registration No.

Delegate Type * Practitioner Resident Speech Pathologist

Registration Category * Non-LVA Member LVA Member International

LVA Membership ID /No *

Do you want to add "Hands-On Laser CO₂" with your Workshop Set? Registration Fee - INR. 2500/- * Yes No

I certify that the information submitted in this application is true and correct to the best of my knowledge.

I further understand that any false statements may result in denial or revocation of the certificate.

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Account and Personal Details

Address

Registration Choices

Select Workshop

Hall 1

Hall 2

Hall 3

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