REGISTRATION FEE

International CME on Renal Pathology

March 14-16, 2005

Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India

Main Page	Invitation	Scientific Program	Organizing Committee
Registration	Accommodation	Faculty	Download Registration Form

Registration Fee

in INR

50% refund will be made for the cancellation of registration till 31^st January 05.

Registration Form

First Name.…...…………......................................Last Name.................................

M/F .......................................................

Designation…………...……..…........................... ...........................................................

Delegate/PG Student.….......................... ..........................................................................

Institution..………………………………...........................................................................

Address for Correspondence

Address.………….….……………………………...…………………..…….......……....

City…………………………………………......................................................................

PIN Code………...………................................................................................................

State......…..…………....…................................................................................................

Tel No.................................................................................................................................

Cell No.…………………………………...........................................................................

Fax No.…........………………………………………........................................................

Email..…………………………………………….............................................................

Food Preference Veg / NonVeg .............................

Accommodation

Category ……..... Single/ Double............................................

From date …………… to date …………… No of nights stay...........................……..

Payment Details

Registration Fee ………………………………...................

Hotel Tariff …………………..………………….................

Accommodation Handling charge ..…………….....................

Total Amount …………………………………...................

(in words) ...........…………………………….. .…………………………………………………….

All payments to be made by crossed D/D in favor of “CME RENAL PATHOLOGY” payable at Lucknow.

Draft No………………Date ……………………..Bank ………………………………………………

Signature