|
Name
________________________________________________________ |
Institution
________________________________________________________ |
Mailing Address _________________________________________________
__________________________________________________
|
City ________________ |
Country _________________ |
Postal Code _____________ |
| Tel. Home ____________ |
Office __________________ |
Telefax _________________ |
E-mail
_________________________________________ |
MENTION SPECIALTY SECTION
Please tick any:
REGISTRATION FEES
Institutional Registration is available
Fees include 3 days of Congress Lunches, Tea, Opening Ceremony, Welcome Cocktail,
Indian Cultural Nite and entry to exhibition area (BANKERS CHARGES NOT
INCLUDED).
* A certificate of Training from Institution Head or Department head is required.
MODE OF PAYMENT
Registration form should be accompained by:
CREDIT CARD (VISA/MASTER)
| Name |
___________________________________________ |
| Number |
___________________________________________ |
| Date of Expiry |
___________________________________________ |
|
Signature
as in the Card
|
BANK TRANSFER : Swift Code : HSBC IN BB - A/c No. 041-152786-006
A/c NAME : DR. B.
KRISHNA RAU ISLSM 2001
DEMAND DRAFT : in favour of "Dr. B. KRISHNA RAU ISLSM 2001"
Chennai.
CANCELLATION : On or before 1st June,
2001 will receive the Registration Fee after
deducting handling charges of 1000/-. No refund thereafter.
|
PROF. B. KRISHNA RAU
President - International Society for Laser Surgery and Medicine
5, Chandra Bagh Avenue, II Street, Mylapore, Chennai - 600004, INDIA
Tel: 91-44-8527776, 8594804 Fax : 91-44-8594578
E-Mail : [email protected] Hotmail : [email protected]
Website : www.medindia.net/islsm2001
Online Registration, Hotel Accommodation
Abstract Presentation and Payment can be done.
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