FORM 'B'
Accomodation/Travel Request Form
(Please fill in full using block letters.)

Personal Details
Name: First ………………………………. Middle ………….……… Surname …………………………
Mailing address……………………………………………………………………………………………..
………………………………………………………………………………………………………………
City……………….………..Pin…………………….State…………………..Country…………………….
Telephone………………… Fax……………………Email……………………………………..………….
Mobile ……………………………..

Travel
Airlines in order of preference: ……………………………………………………………………………….
Arrival: ……………………………………………………………………………….
Departure: ……………………………………………………………………………….
Transfer: [ ] Required [ ] Not required

Accomodation (in order of preference)
1. Hotel .………………………………………………………… (Single / Double / …………………………….)
2. Hotel .………………………………………………………… (Single / Double / …………………………….)
3. Hotel .………………………………………………………… (Single / Double / …………………………….)
4. Hotel .………………………………………………………… (Single / Double / …………………………….)

Tours (Sightseeing)
………………………………………………………………………………………………………………………..
………………………………………………………………………………………………………………………..

Meals: [ ] Vegetarian [ ] Non-vegetarian

Dr. G Choudhuri
Joint Organizing Secretary
Department of Gastroenterology
SGPGI, Lucknow 226014, India
Ph. +91-522-440700 extn 2400, 2428
Fax: +91-522-440017
Email: isg2001@sgpgi.ac.in, gc@sgpgi.ac.in
Website: www.sgpgi.ac.in/conf/isg2001.html