BSLMS Workshop Registration

Personal & Professional Details

Full Name *

Gender *

Date of Birth*

Mobile Number *

Email ID *

Postal Address *

State *

City *

Professional Background

Designation *

Years of Experience *

Upload your MD / DNB DVD/ certificate / PG Students to upload college ID proof *

Upload your passport-sized photo here*

Institution / Clinic Name *

Specialty / Practice Focus *

Laser Experience Level *

Interested Laser Systems / Procedures *

Previous Event Attendance & Bank Details

Have you attended any BSLMS events previously? *

Registration & Declaration

GST No

GST Name

Amount (Including GST) *

Self Declaration:

I am a qualified dermatologist meeting the eligibility criteria for the BSLMS membership category I am applying for.
I understand that BSLMS membership is subject to verification and approval by the BSLMS Secretariat, and submission of payment does not automatically guarantee membership confirmation.
I agree to abide by the BSLMS Code of Ethics, Standards of Practice, and Society policies, as applicable to my membership.
I understand that membership benefits commence only after successful verification and confirmation by BSLMS.
I acknowledge that any special or introductory offer is subject to eligibility verification based on BSLMS records, and applicable refunds (if any) will be processed only after backend verification.
I agree that the BSLMS name, logo, and affiliation will be used by me responsibly and only in accordance with Society guidelines.

I confirm that the information provided by me during registration is true, accurate, and complete to the best of my knowledge.