Venue : May Fair Lagoon
For Travel Arrangement & Tour’s
Contact :
Travel Desk
Hotel May Fair Lagoon
Phone- 91-674-2360101
 
 
 
 
 
 

Registration
Click here to Download the Registration Form           
 
Registration Fee Before 31st May 2008 After 31st May 2008 Spot
Delegates Rs. 1600/- Rs. 2200/- Rs. 2500/-
Residents Rs. 1000/- Rs. 1000/- Rs. 1500/-
Accompanying person Rs. 1000/- Rs. 1500/- Rs. 2000/-
Foreign delegates (US Dollar) $ 100 $ 150 $ 250

Submit online with intimation to the organizing secretary and pay the registration fee in Punjab National Bank in Account No - 0553000110009132. Or please fill in and send along with the registration fee to:
Address of Communication
Prof. Sureswar Mohanty
206, Duplex, Manorma Estate
Rasulgarh, Bhubaneswar-751010
Email: principal_ims@yahoo.co.in
Phone: 0674-2585484
 
Online Registration
Name  * Hospital  *
Hospital Address  * Title/position  *
Department  *
Accompanying person (name) Mailing Address
City *
Zip Code *
Country
Telephonic Contact Information Other Contact Information
Country Code Fax
City Code Mobile
Residence No. E-mail
Office/hospital No. Name (as you would like printed on badge)                    
*
ONLY FOR DELIGATES FROM ABROAD
Passport No. Date of Issue   Click Here to Pick up the date
Place of Issue Validity
Nationality    
Accompanying Persons Information
Information of first person Information of second person
Name Name
Passport No. Passport No.
Date of Issue   Click Here to Pick up the date Date of Issue   Click Here to Pick up the date
Place of Issue Place of Issue
Validity Validity
Nationality Nationality
Information of third person Information of fourth person
Name Name
Passport No. Passport No.
Date of Issue   Click Here to Pick up the date Date of Issue   Click Here to Pick up the date
Place of Issue Place of Issue
Validity Validity
Nationality Nationality
   
 
 
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