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Registration Form

First Name

57thAICO
Innovation to Implementation

Patna

57th All India Congress of Obstetrics & Gynaecology


1 - 5 February, 2014 | Bihar Veterinary College (BVC) Sports Ground, Patna

2014

Organised by:

Under the aegis of:

Middle Name

Last Name

Name* Designation Institute Address City State Telephone E-mail# Accompanying Persons 1 2
#

Sex

Age

Pin Code Country Std: Fax: (R) (O) Mobile#

Email & Mobile Number Mandatory


Uro-Gynecology Hysteroscopy Imaging Practical Obstetrics Infertility

Workshop Selection (Please tick any one)


Fetal Medicine Medico Legal Laparoscopy Gynae Oncology

Payment Details (Tick whichever is applicable. The Amount is inclusive of all Applicable taxes) Registration Fees
Workshop
CME FOGSI Member Non-FOGSI Member P .G. Students* Accompanying Person Banquet Fees Foreign Delegate

21st Jan13 to 30th Sep13 ` 3596 ` 1686 ` 7304 ` 8427 ` 4495 ` 6742 X ` 2809 X ` 16854

1st Oct13 to 31st Oct13


` 5057 ` 2809 ` 8989 ` 10113 ` 5618 ` 7866 X ` 2809 X ` 16854

1st Nov13 to 31st Dec13


` 6180

Total

` 3933 ` 10113 ` 11236 ` 6742 ` 8989 X ` 3371 X ` 19663

Grand Total >>


I am enclosing herewith Cash/Demand Draft* No Dated............................Drawn on..................... of Rs(fig.)...........(words).............................. in favour of 57 AICOG 2014, Patna payable at Patna, India
th

Meal Preference

Veg

Non-Veg

Jain

Children below 7 Year, if any (no fees applicable) Name 1............................................................ 2............................................................ Age .......... ..........

Signature..........

Date..............
Please turn overleaf for Registration Guidelines

Registration Form

57thAICO
Innovation to Implementation

Patna

57th All India Congress of Obstetrics & Gynaecology


Bihar Veterinary College (BVC) Sports Ground, Patna

Please complete and return at your earliest convenience to: Congress Secretariat 57th AICOG 2014 Gynae Wing, IMA Building Dr A K N Sinha Path, Patna - 800004, Bihar
Registration Guidelines
The registration categories and fees are listed in the registration form. The duly competed form with the payment

Phone:+91 0612 2321542 Moblie: +91 8002634964 Email: secretariat@aicog2014patna.com Website: www.aicog2014patna.com

should reach the conference secretariat at the address given in the registration form.
Congress registration is mandatory for registration in workshop & CME Registration will be valid only on the date of receipt of payment instrument. Registration fees will be calculated as

applicable on the date of receipt of payment of instrument.


Senior doctors above the age of 75 years can attend AICOG 2014 Patna without any registration fees. However, filling

of form is mandatory. Also please submit age proof.


Accompanying persons & children will not be allowed to the scientific sessions * It is mandatory of P.G. students to submit a letter from the Head of Department/Head of Unit

Overseas Delegates
Delegates from other countries need to be registered as per the registration details

Accompanying Delegates Activities for accompanying delegates will be organised at the conference venue. Accompanying delegates will not be allowed in the scientific halls Mode of Payment
Online Credit Card Payment: visit www.aicog2014patna.com Offline Payment: You can make your registration payment through Demand Draft for the appropriate amount in

favor of 57th AICOG 2014, Patna payable at Patna, Bihar. You can also pay the registration payment through Bank Transfer. The details are Bank Name : Canara Bank Branch: Patna South Gandhi Maidan (352) Ac Name: 57th AICOG 2014 Ac/No: 0352101041251 IFSC Code: CNRB0000352 The Conference organizers are not responsible for postal delays/failure of delivery by post or failure of electronic communication. Please keep the confirmation letters along with the registration details safe and produce them at the registration counter while checking in the conference venue. This is COMPULSORY Refund Policy
Email received for cancellation/refund will have to be supported by subsequent formal written letter. Those who have

intimated their non-participation in writing to the conference secretariat will only be considered for refund as applicable on the date of receipt of the intimation of non-participation. Refund will be made only after the conference. Refund will be paid by cheque only. 75% of total registration fees will be refunded if the cancellation request is received before 15th October, 2013. No refund after 15th October, 2013

Official Event and Travel Managers Thomas Cook (India) Ltd / Travel Corporation (India) Ltd, Plot No. 520, Udyog Vihar, Phase - III, Gurgaon 800 001, Haryana P: +91 124 6120263 | F: +91 124 6120282 | Email: secretariat@aicog2014patna.com | Website: www.tciconferences.com

2014

Organised by:

Under the aegis of: