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24th - 27th January,
2002
Registration Form
Delegate's
Title :  Dr.
Prof. Mr.
Ms. IAP
Membership No : ................................... |
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| Preferred
Name : |
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| Mailing
Address : |
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| City
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Pin
Code: |
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| Cell
Phone : |
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Tel
(0) : |
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| Email: |
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Tel
(R) : |
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| Fax
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Veg Non
Veg |
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Accompanying
Person
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Fees
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Registration
is Essential
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Delegates
: I.A.P
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Rs :
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Delegates
: Non- I.A.P
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Rs :
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| Accompanying
Person : |
Rs :
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| CME
Programme : |
24th
January 2002 |
| Pre Conference
Workshop : |
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| PG Student
: |
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| Foregin
Delegates : |
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| Mode
of Payment : |
By Cash/Demand
Draft only, in favour of Pedicon 2002 payble at Bangalore. |
| Delegate
Hospitality : |
Entry
to commercial exhibition, |
| Cancellation
and Reimbursement |
Any
cancellation or changes must be in writing only.
Before 30th November 2001 -- 50%
After 30th November 2001 -- No reimbursement |
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Date
..................... Signature
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Note : Please
Mail the Registration Form or Photocopy along with DD by Registered
Post only.
To:
The Organizing
Secretary, PEDICON 2002, Children's Clinic, #556, 7th Main 5th Cross,
Vijaynagar, Bangalore 560 040, Karnataka, India
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Registration Information
| Delegate
Category |
Before
30.05.2001 |
Before
31.08.2001 |
Before
31.10.2001 |
Before
31.12.2001 |
Spot |
| IAP Member |
Rs. 1,800 |
Rs. 2,800 |
Rs. 3,500 |
Rs. 4,200 |
Rs. 5,000 |
| Non IAP
Member |
Rs. 2,300 |
Rs. 3,300 |
Rs. 4,000 |
Rs. 4,700 |
Rs. 5,500 |
| PG Student |
Rs. 1,200 |
Rs. 1,500 |
Rs. 1,900 |
Rs. 2,300 |
Rs. 3,500 |
| Accompanying
Person |
Rs.
1,200 |
Rs.
2,000 |
Rs. 2,500
|
Rs.
3,000 |
Rs.
4,000 |
| Foreign |
UD$ 200 |
UD$ 300 |
UD$ 400 |
UD$ 500 |
UD$ 600 |
| SAARC |
UD$150 |
UD$ 250 |
UD$ 350 |
UD$ 450 |
UD$ 550 |
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Note : Application of PG Student should have been endorsed by the
concerned H.O.Ds.
Registration
Procedure: All application should be made on the perscribed registration
form (one form per delegate) accompained by corresponding fees amount
in Cash or Demand Draft in favor of 'Pedicon 2002' payble at Bangalore
and sent to :
Dr. K. Jayoji
Rao,
The Organizing
Secretary
Childeren's Clicnic, # 556, 7th Main,
5th Cross, Vijaynagar, Bangalore 560 040, Karnataka, India
Telephone : 080 3301 707 (O) 080 3492707 (R)
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