Registration for Neurocon 2008, Pune

• Name

SURNAME

FIRST NAME

MIDDLE NAME

To be filled in Block Letters Only

• NSI Member No. (Mandatory)

• Mailing Address

• City

• State

• Pin.

• STD Code

• Phone (Work) • (Res.)

• Mobile

• E-mail ID

• Acc. Person

Please note: It is essential to have a functional e-mail ID & working cell phone
as ALL communications regarding your Registration shall be done by E-mail & SMS.

Registration Fees
	Regular	With late	Spot
	31/07/08	31/10/08	Spot
NSI Member	4000	5000	5500
Residents*	2000	2500	2750
Non Members	8000	10000	11000
Acc. Persons	2000	2500	2750
SAARC Delegates	500 $ USD	600 $ USD	700 $ USD
Internationl Delegates	600 $ USD	700 $ USD	800 $ USD
* Letter from HOD must Registration fees include CME, Conference & Official Meals (4 Breakfasts and Lunches & 3 Dinners)

PG Student Delegates shall be provided with subsidized accommodation on a first come first serve basis in the AFMC Campus. The rooms are on a sharing basis and are limited. Please contact the Conference Secretariat at nscon2008@yahoo.co.in to confirm the same.

Payment Details

• Please find enclosed DD / Cheque No.

• Dated • Drawn on

• For Rupees

Please send cheque payable at par/draft in favour of

"NEUROCON 2008" payable at Pune to

Conference Secretariat -
Col. S P Gorthi
Sr. Advisor Med & Neurology
Professor of Medicine,
Dept. of Internal Medicine,
Armed Forces Medical College
Pune 411 040 • Telefax: 020 - 26332229
Email - nscon2008@yahoo.co.in