Privilege Card Registration Form – Jaiprakash Hospital And Research Centre

Privilege card Form

Privilege Card Registration Form

* Notice: The last date of submission is 30th June 2025*

First Name

Last Name

Date of Birth

Gender

Male

Female

Others

UHID No. (If Existing Patient)

Privilege card will be sent to the following address.

Address Line 1

Address Line 2

City

State

Postal Code

Country

Name of the Institute

Designation

Phone/Mobile

WhatsApp Number

Email

Aadhaar Number

Upload your Aadhaar card ( jpg,jpeg,png,pdf)

Choose File

* Notice: Before submitting the request, Please verify the entries done by you. Once you submit, the request will not be editable.*

By submitting this application, I hereby confirm that I do not possess any government-issued health card (e.g., BSKY, Ayushman Bharat) or a JP card. I also give consent to being contacted by JP Hospital representatives in the provided contact number if necessary for further processing of this application.

Privilege Card Registration Form

Rules and Regulations for JP NURSICON 2025

By registering for JP NURSICON 2025, I acknowledge and agree to the following terms and conditions:

Accuracy of Information:
- I confirm that the details provided in the registration form are true and accurate to the best of my knowledge.
- Any false or misleading information may result in cancellation of my registration without a refund.
Registration and Payment:
- My registration will be considered valid only after successful payment confirmation.
- The registration fee is non-refundable and non-transferable under any circumstances.
- Accommodation, if opted for, is provided on a shared basis with basic amenities.
Participation and Conduct:
- I agree to maintain professionalism and decorum throughout the event.
- Any misconduct, inappropriate behavior, or violation of conference guidelines may result in my removal from the event without a refund.
Event Attendance and ID Verification:
- I must carry a valid government-issued ID or my institutional ID for verification at the registration desk.
- Entry to the conference venue will be granted only to registered participants with a valid conference ID badge.
Workshops and Scientific Sessions:
- Participation in hands-on workshops will be subject to prior registration and seat availability.
- I understand that workshop materials and session content are intellectual property and should not be recorded, copied, or distributed without prior permission.
Liability Disclaimer:
- The organizing committee and Jaiprakash Hospital shall not be held responsible for loss, theft, or damage to personal belongings during the event.
- I agree to adhere to all safety protocols and event guidelines provided by the organizers.
Media Consent:
- I grant permission for my photographs, videos, or testimonials taken during the event to be used for promotional and educational purposes by the organizers.
- If I do not wish to be photographed or recorded, I will inform the event organizers in advance.
Health & Safety Compliance:
- I will comply with any health and safety measures implemented by the event organizers, including COVID-19 protocols (if applicable).
Modification of Terms:
- The organizing committee reserves the right to modify the event schedule, speakers, or rules at any time without prior notice.

📌 By checking this box, I confirm that I have read, understood, and agree to abide by the Rules and Regulations of JP NURSICON 2025.