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  • IOACON 2012 Registration Form

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    Sanket Patil
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    This document contains a registration form for the 57th Annual Conference of the Indian Orthopaedic Association being held in Chennai, India from December 12-16, 2012. It requests personal information from attendees such as name, affiliation, payment details. It provides options to register for the conference, accompanying persons, CME events, workshops and a banquet. It notes the address to submit forms and requirements for registration of different attendee groups such as PG students and children. It also outlines policies regarding cancellation, refunds and deadlines.

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    Registration Form

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    This document contains a registration form for the 57th Annual Conference of the Indian Orthopaedic Association being held in Chennai, India from December 12-16, 2012. It requests personal information from attendees such as name, affiliation, payment details. It provides options to register for the conference, accompanying persons, CME events, workshops and a banquet. It notes the address to submit forms and requirements for registration of different attendee groups such as PG students and children. It also outlines policies regarding cancellation, refunds and deadlines.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
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    232 views3 pages

    IOACON 2012 Registration Form

    Uploaded by

    Sanket Patil
    This document contains a registration form for the 57th Annual Conference of the Indian Orthopaedic Association being held in Chennai, India from December 12-16, 2012. It requests personal information from attendees such as name, affiliation, payment details. It provides options to register for the conference, accompanying persons, CME events, workshops and a banquet. It notes the address to submit forms and requirements for registration of different attendee groups such as PG students and children. It also outlines policies regarding cancellation, refunds and deadlines.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 3

    IOACON2012

    57 AnnualConferenceof
    IndianOrthopaedicAssociation
    CHENNAI(12th16thDECEMBER2012)
    REGISTRATIONFORM
    PersonalInformation
    th

    Passport
    Photo

    MemberIOANonMemberSeniorCitizenForeignDelegateTradeDelegatePGStudent

    IOAMembershipNo:.
    FirstName:Surname:.MiddleName:
    Designation:NameofInstitution:
    ..
    Address:.....................................

    City:State:.Pin:..Country:..
    TelephoneNo.(LandLineWithSTDcode):.MobileNo:..
    Email(ValidandActive):..

    DETAILSOFACCOMPANYINGPERSONS

    NameAgeRelationshipwithdelegate(PhotosofAccompanyingPersons)
    .
    .....
    ..

    DetailsofPayment
    Amount
    Workshop(SpecifyPreference)

    Conference:....................................................................
    AccompanyingPerson:..
    CME:....
    Workshop:..
    Banquet:For.Persons.
    Incidental:200/

    Total:.

    IamenclosingaDemandDraft(DD)ofRs:.Date:
    DDNo:Draftat:.infavourofIOACON2012chennai
    PayableatChennai.

    SignatureofDelegate


    FORSECRETARIATUSE

    RegistrationNo:...ReceiptNo:....................Duesandnotingifany:.............
    .....................................................SignatureforIOACON2012;.........................................

    MailTo

    Dr.MayilVahananNatarajanM.S.Orth.D.Sc.
    OrganisingSecretaryIOACON2012
    4,LakshmiStreet,Kilpauk,Chennai600010
    Landline:04426600079
    Email:orgsec@ioacon2012.org
    Web:www.ioacon2012.org

    MobileNo9445205673.

    PleaseNote

    PGStudentsshouldenclosethecertificatefromheadofthedepartment

    Allchildrenabove10yearsofagehavetoregisterasaccompanyingperson

    Childrenbelow7yearsofagehavetoberegistered(freeofcharge)forlogisticsandsecurity
    reasons.

    Accompanyingperson&childrenwillnotbeallowedinscientificsessions.

    TheOriginalAcknowledgmentletter/Receiptmustbepresentedatregistrationcounterat
    theconferencevenue.

    Secretariatdoesnotacceptanyliabilityfortheformslostordelayedintransit.

    SeniorIOAmemberabove65yearsofageareexemptedfromconferenceregistrationFee,
    buttheymustsendfilledRegistrationForm.

    Cancellation&Refund.

    Refundofregistrationwillbemadeonlyagainstthewrittenrequestsubmittedtothe
    conferencesecretariat.

    Cancellationispermittedupto31stOctober2012afterwhichnorefundrequestwillbe
    entertained

    25%oftheregistrationwouldbedeductedasprocessingcharges.

    Allrefundswillbemadeafteronemonthofthecertificate.

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