SN ONGC DEPARTMENT OF GENETICS AND MOLECULAR BIOLOGY Vision Research Foundation Visit us at: www.sankaranethralaya.org REGISTRATION FORM 2nd SN GENETICS Convention 2014: ‘Sanger to NGS – The Genomics Era’ 30th and 31st January 2015 Name: __________________________________________________________________________________________ Designation: _____________________________________________________________________________________ Organization/College: _____________________________________________________________________________ Address: ________________________________________________________________________________________ _______________________________________________________________________________________________ City: _______________________________________________ Pin Code: ___________________________________ Phone: _______________________________________Mobile: ___________________________________________ E- mail: ________________________________________________________________________________________ REGISTRATION FEE: Rs.1000/- (for students) and Rs.2000 (for others). 1. By Demand draft/ Banker’s cheque: Registration fee of Rs. _______________ via DD no. / dated _____________________, bank name ___________________________________________ drawn in favor of Vision Research Foundation payable at Chennai. 2. By NEFT Transfer Students/ Delegates can make payment by NEFT transfer using the following bank details: Name: Vision Research Foundation Bank Name: HDFC Bank Ltd. Branch Address: Nungambakkam branch, No.40, Nungambakkam High Road, Chennai-34. Bank Account Number: 00821000092917; IFC code- HDFC0000082 Please forward the filled in registration form to, The Organizing Secretary, 2nd SN GENETICS Convention 2014, Dr.A.Jayamuruga Pandian, Head and Reader, SNONGC Department of Genetics and Molecular Biology, Vision Research Foundation, Sankara Nethralaya, 18 / 41, College road, Nungambakkam, Chennai, India. Phone No.: +91-44-42271807; Email id: [email protected], [email protected] On-spot registration will be available. Venue for the Session: Sri V.D Swami Auditorium, Sri T.S Santhanam Floor (VII floor), KNBIRVO Block, Sankara Nethralaya, No. 18/41, College Road, Nungambakkam, Chennai – 600006. Note: • Course fee is non-refundable; however change in nomination is acceptable. • Prior registration is essential. • Kindly attach a copy of your college ID card for student registration. Signature