|
REGISTRATION FORM
Dr. Bhawna Sirohi
(Artemis Cancer Centre)
Organising Secretary
Email:bhawna.sirohi@btinternet.com
Mb No : 09871233980
Off No : 01246767999 Ext.: 7220
Off Add: Artemis Cancer Centre Artemis Health Sciences Sector 51, Gurgaon- 122 001
Haryana.
Dr.
I am in receipt of the circular for the 24th ICON meeting being organized by you
on 11th-13th March, at New Delhi.
I will / will not be attending the meeting. My registration fees of Rs 500/ Rs 1,000
is enclosed.
I will make my own travel reservations as follows:
I will be arriving by flight/train no
on
 (date) at
hh:mm (arrival time).
I will be leaving by flight/train no
on
(date) at
hh:mm (departure time).
I understand that local arrangements will be available to eligible active fully
paid non industry ICON member whose registration reaches you on or before
If I am an eligible ICON Member, I will receive travel grant equivalent to 50% of
the super-apex airfare (between my city and
by the shortest route) only
if I attend the full two day scientific program.
I will be accompanied by
persons. The payment will be sent to you latest by
.
|