Welcome to Transplantation Update 2010

» CPC

Registration form

Please use one registration form per delegate. Kindly use a photocopy of this form, for registration of additional delegates or accompanying persons.

Personal Details:

First name :

Middle name :

Last name :

Birth Day :

Gender :

Male Female

Address :

Clinic

Residence

City :

State :

Country

Phone No :

(C)

(R)

(M)

Email :

Website :

Category :

Please tick :

Please include my name in your mailing list.
I plan to attend the Seminar.
I intend to present a paper.
I/We shall require accommodation.

Payment Details:
PAYMENT	DD/ Cheque No:	Date	Bank Details	AMOUNT Before 31st Jan 2010	AMOUNT Spot Registration
Delegate		(YYYY-MM-DD)		Rs. 2000	Rs.2500
Accompanying Person		(YYYY-MM-DD)		Rs. 1000	Rs. 1500
P G Student		(YYYY-MM-DD)		Rs. 1000	Rs. 1500
Staff Member		(YYYY-MM-DD)		Rs. 1000
TOTAL				*
Note: · (P.G. Students duly certified by H.O.D.) · Last date for abstract submission is 31st January, 2010. · Registration mandatory for oral/ poster presentation · Attractive prizes for oral/ poster presentations
I accept the above terms and conditions.