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Nehru Science Centre, Worli, Mumbai
27th March 2011 |
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Registration Form (Closed)
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| First Name: |
_______________________ |
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Last Name: |
______________________________ |
| Address: |
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Payment Details: Circle the one selected
Registration |
Till 31st January 2011 |
1st February 2011-10th March 2011 |
Spot Registration |
Delegate |
Rs 750 |
Rs 850 |
Rs 1000 |
PG Student |
Rs 500 |
Rs 600 |
Rs 750 |
*PG Student (Enclose Certificate from HOD)
(Add Rs 75/- additional for outstation cheques)
I am enclosing a Demand Draft/ Cheque # __________________________ drawn
on ______________ bank _____________________________________________ branch,
dated _______________ for a total payment of Rs ________________________________
in favour "Practical Pediatrics Update " payable at Mumbai
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