Indian Association of Public Health Dentistry
IAPHD-TamilNadu Chapter
In Association with
Karpaga Vinayaga Institute of Dental Sciences
Department of Public Health Dentistry
IAPHD
16th Convention
16th Convention
2025
Registration Form
Registration Form
KIDS PHD
Select Title
*
Dr.
Mr.
Mrs.
Miss.
Full Name (Capital Letter)
*
Email
*
Mobile Number
*
WhatsApp Number
*
IAPHD Membership No
*
Gender
*
Male
Female
Prefer not to say
Designation
*
Postgraduate
Faculty
Other/ Accompanying Person
Payment Reference ID
*
Payment Drawn Bank
*
Institution
*
Address of the Correspondence
*
Country
*
State
*
City
*
Upload receipt
*
Upload up to 5 supported files: PDF, document, or image.
Choose File
Maximum file size: 134.22MB
Upload Photo
*
Upload recent passport size colored photograph in jpg, jpeg format only
Choose File
Maximum file size: 134.22MB
Submit
If you are human, leave this field blank.
