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ISSN 0973 - 0958
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3RD PEDIATRIC INFECTIOUS DISEASES CONFERENCE
CLINICAL DILEMMAS
Nehru Science Centre, Worli, Mumbai - 400 018.
9th December 2012
REGISTRATION FORM
| First Name: | Last Name: | |||
| Address: | ||||
| City: | Pin Code: | Country: |
| Specialty (tick mark): | Pediatrician | Physician | |||
| Post Graduate | GP | Other Specify....... | |||
| Telephone numbers (Including STD Code): | |||||
| Residence: | Office: | Mobile: | |||
| Email: | |||||
Payment Details: Circle the one selected
| Registration | Till 31st Aug. 2012* | 1st Sept 2012-15th October 2012* | 16th October 2012 - 30th November 2012* |
| Delegate | Rs 1200 | Rs 1500 | Rs 1800 |
| PG Student | Rs 800 | Rs 900 | Rs 1000 |
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*PG Student (Enclose Certificate from HOD) (Add Rs 80/- additional for outstation cheques)
I am enclosing a Demand Draft/ Cheque #________________________________ drawn on _________________________ bank ___________________________________ branch, dated ____________________ for a total payment of Rs _________________________ in favour "Pediatric Oncall Journal" payable at Mumbai. |
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| Date________________________ | Signature_______________________ |
Conference Secretariat
Pediatric Oncall, 1/B Saguna, 271/B St. Francis Road, Vile Parle (W), Mumbai 400056.
Tel: 022- 32217624. Email: pedconference@gmail.com Website: www.pediatriconcall.com
Pediatric Oncall, 1/B Saguna, 271/B St. Francis Road, Vile Parle (W), Mumbai 400056.
Tel: 022- 32217624. Email: pedconference@gmail.com Website: www.pediatriconcall.com
Registration cancellation Policy
◊ Cancellations received up and including August 31, 2012- full refund less Rs100 handling fee.
◊ Cancellations received between Sept 1 and 15th Oct, 2012 - 50% will be refunded.
◊ After October 16th, 2012- no refund will be made.
◊ Cancellations received up and including August 31, 2012- full refund less Rs100 handling fee.
◊ Cancellations received between Sept 1 and 15th Oct, 2012 - 50% will be refunded.
◊ After October 16th, 2012- no refund will be made.
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Disclaimer:
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