International conference cum live workshop

Société Internationale d’Urologie

NZ-USI & SELSI

Venue: Sheri Kashmir International Convention Complex, Srinagar, Kashmir (INDIA)

Forms

REGISTRATION FORM
Name_________________________________________________________________________________________________

Designation

_____________________________________________________________________________________________________

Institute ______________________________________________________________________________________________

Correspondence Address_________________________________________________________________________________

___________________________________________________________State______________________________________

City________________________________________________________Pin________________________________________

Accompanying Person (1) _____________________________________ (2) ________________________________________

Accompanying Person (3) _____________________________________ (4) _______________________________________

CONTACT DETAILS

Landline (Resi) __________________________________________ Office_________________________________________

Mobile_________________________________________________Fax____________________________________________

E mail________________________________________________________________________________________________

PAYMENT DETAILS

Amount_______________________________________________________________________________________________

Drawn on bank_________________________________________________________________________________________

Draft Number___________________________________________________Dated__________________________________

For Official use only
Registration Number: __________Ack. sent on: ___________Computer No: _______________Date: / /2009

By Post ( ) / Email ( ) date: / /2009 Balance Amount: Rs________________________

ACCOMMODATION FORM
Name _______________________________________________________________________________________________________

Accompanying Person (1)______________________________(2)________________________________________________________

(3)__________________________________________(4)_______________________________________________________________

Address_______________________________________________________________________________________________________

_____________________________________________________________________________________________________________

City____________________________State________________________PIN_______________________________________________

Email_________________________________________________________________________________________________________

Tel: (Off) _________________________________ (Resi) _______________________________________________________________

Fax No___________________________________ (Mob)________________________________________________________________
PAYMENT DETAILS
Amount
__________________________________________________Rs._____________/-
(in words)
Demand Draft No_______________________________Dated____________________________________________________________
Drawn on
______________________________________________________________________________________________________________
(Bank)

ACCOMMODATION DETAILS
Preferred Hotel: 1______________________________________2_______________________________________________________

For official Use
Single: ________________________Double_________________________________________________________________________

Computer No: _________________________________________________________________________________________________

Ack. sent on: _____________________________________

Check in ______________________Check out_________________________

No:_____________Dt: / /2009

By Post( ) /Email( )dt: / /09

Balance Amt: Rs_____________

Date____________/______/ 2009

Signature
NOTE: -

For booking send this form (to Conference Secretariat) along with advance for “One Night Room Tariff” charges in the form of Demand Draft drawn in favour of “EARTH EXPLORERS” payable at Srinagar, Kashmir.

EARTH EXPLORERS
Travels & Tours
Head Office:
“Narwari Manzil” Court Road, AmiraKadal
Srinagar – 190 001 Kashmir (India)