Please fill this form and mail it with your non-refundable payment of fee to:

Vishwas Sathe MD
Professor Anaesthesiology - Cardiac Unit
Incharge & Training Centre Coordinator (TCC)
MGM Skills Lab -AHA ITC #-ZZ21290
Email: skillslabnm@mgmuhs.com
Phone : +91 976 99 81 999

Please mention your specific email ID registered with AHA as an Instructor only.

Payment Modes: Please deposit the fees through the bank draft in favor of "MGM MEDICAL COLLEGE NAVI MUMBAI" through Bank draft, payable at Mumbai

OR

It can be paid by direct transfer as per the following
Name: MGM MEDICAL COLLEGE NAVI MUMBAI
Bank Name: IDBI Bank Branch: CBD Belapur ACCOUNT TYPE:Saving Account
A/C No.: 0183104000108348 SWIFT Code: IBKLINBB183 NEFT/IFSC Code: IBKL0000183
No form will be accepted without full payment. Provide details of Bank Draft No:……………….
Dated :…………… Drawn on:…………………

OR

Prefer our online payment link of SBI Collect, Google as “State Bank Collect – Online SBI” details enclosed as below
Signature:

COURSE FEE DETAILS:( Pl tick the course you are enrolling for.)

BLS TCF	Rs.3000/-
BLS & ACLS TCF	Rs.5000/-
BLS & PALS TCF	Rs.5000/-
BLS,ACLS & PALS TCF	Rs.7000/-

Note:Submit payment receipt from SBI collect portal OR screenshot of RTGS/Netbanking with TRN/RRN no. & registration form at skillslabnm@mgmuhs.com