PRINT NAME AS TO APPEAR ON CERTIFICATE
PRC EXPIRY DATE
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By registering in this post graduate course, I hereby confirm that I authorize PENTAMED and its affiliates to collect, process, store the information provided in this registration form for legitimate business purposes, as proof of my attendance and participation in this event which may be published accordingly and for any follow up business activities related to my participation in this event.
I give my consent for my NAME and EMAIL ADDRESS to be shared with the industry partners only for attendance purposes in the industry sessions.
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