Diabetes - Endocrinology
Update 2007
17th - 18th
March, 2007
Registration Form
(Print, Fill & Dispatch)
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Name |
First |
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Last |
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Age/Sex |
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Address |
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______________________________ |
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Tel No |
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______________________________ |
Fax No |
______________________________ |
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E-mail |
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Amount
enclosed |
_________________________ |
Registration |
_________________________ |
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Accommodation
|
_________________________ |
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Accompanying
person |
_________________________ |
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Total
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_________________________ |
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Bank
Draft/Cheque No |
_________________________ |
Date |
_________________________ |
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I
expect to be accompanied |
_________________________ |
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I
need accommodation |
_________________________ |
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Category
Ist choice |
_________________________ |
2nd
choice |
_________________________ |
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Date
of Arrival Departure |
_________________________ |
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*Request for accommodation
and travel arrangements should be preferably confirmed by 28th February,
2007.
Scientific Programme Registration
& Accommodation Registration Form