Delegate Registration Form

INDIA INTERNATIONAL AYURVEDA AND WELLNESS EXPO AND SUMMIT 2026

January 23-25, 2026 | Goa

Delegate Type Selection

Whether Students from AYUSH colleges in GOA and Practitioners/Doctors registered with Goa Council of Ayurveda and Other Allied Indian System of Medicine *

Are you a Student or a Practitioner/Doctor? *

Council Registration No. *

Delegate Type *

Upload Student ID Card (PDF only, Max 2MB) *

Please upload your student ID card in PDF format (maximum size: 2MB)

Personal Information

Title *

First Name *

Last Name *

Nationality *

Email ID *

Mobile Number *

Alternate Mobile

Address Details

Address Line 1 *

Address Line 2

City

State/Town

Pincode/Postal Code/Zip Code *

Country *

Organization & Additional Details

Organization Name *

Registration Number (IF ANY)

Additional Notes

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