34TH N.W Z AOICON & 3RD Hands on



Endoscopic Cadaveric Dissection Workshop


Sept. 24TH – 26TH 2010


DEPARTMENT OF ENT AND ANATOMY


DAYANAND MEDICAL COLLEGE & HOSPITAL , LUDHIANA.





REGISTRATION FORM





Name (as you like it to be written on the certificate)………



Age……… sex…



Mailing address……………………………………………..

………………………………………………………………..

………………………………………………………………..

Tel……………………….. Fax…………………………….

Mobile:…………………….E mail…………………………





Draft Amount: ____________________________________

Draft No.:________________________________________

Registration:______________________________________



Registration Fee:             Upto           After


                                    15 Aug        15 Aug       Spot

Delegate Registration     800            900            1000

PG Resident Registration  500        600              700
(Recommendation from HOD)

Reg.fee for Conf. & cadaveric dissection
Dissector                     3000

Observer                     2000

D/D or Cheque in favour of ORL, DMC, payable at Ludhiana.




The above will include course materials,

Lunch, tea/coffee, and the course banquet

TERMS AND CONDITIONS

1. The completed form should be sent to the organizing secretary at the earliest possible

Date accompanied with registration form.

2. This form must be accompanied by a demand draft in favour of ORL, DMC, payable at Ludhiana.





Dr. Hemant Chopra

Org. Chairman, NWZAOICON

Prof.& Head, ENT Department

DMC& Hospital, Ludhiana

REGISTRATION FORM

                                             34TH N.W Z AOICON & 3RD Hands on



                                              Endoscopic Cadaveric Dissection Workshop


                                                          Sept. 24TH – 26TH 2010

                                         DEPARTMENT OF ENT AND ANATOMY


                           DAYANAND MEDICAL COLLEGE & HOSPITAL , LUDHIANA.





                                                     REGISTRATION FORM





Name (as you like it to be written on the certificate)………



Age……… sex…



Mailing address……………………………………………..

………………………………………………………………..

………………………………………………………………..

Tel……………………….. Fax…………………………….

Mobile:…………………….E mail…………………………





Draft Amount: ____________________________________

Draft No.:________________________________________

Registration:______________________________________



Registration Fee:                                    Upto              After


                                                            15 Aug             15 Aug             Spot

Delegate Registration                             800                 900                  1000

PG Resident Registration                       500                 600                     700
(Recommendation from HOD)

Reg.fee for Conf. & cadaveric dissection
Dissector                                             3000

Observer                                             2000



D/D or Cheque in favour of ORL, DMC, payable at Ludhiana.



The above will include course materials,

Lunch, tea/coffee, and the course banquet

TERMS AND CONDITIONS

1. The completed form should be sent to the organizing secretary at the earliest possible

Date accompanied with registration form.

2. This form must be accompanied by a demand draft in favour of ORL, DMC, payable at Ludhiana.





Dr. Hemant Chopra

Org. Chairman, NWZAOICON

Prof.& Head, ENT Department

DMC& Hospital, Ludhiana