1. Healthcare

HPLC Workshop – RRMCH – ACBI
28 th and 29th January 2015
REGISTRATION FORM
Name………………………………….………………………………………………
Address including details of hospital/Institution/Company…………………………………………………………………
……………………………………………..……………………………………………………………………………………………..
Mobile No……………………………………………………….. Land line No…………………………………………………………….
Contact e.mail ID for rapid communication ………………………………………………………..……………………………….
DD / NEFT Details:
Amount Rs………………………………… (In words Rs………………………………………………………..…………… )
Dated ………………………………………………………..Number ………………………………………………………
Drawn on (Bank Name) ………………………………………………………..………………………………………………………..
Kindly Note:
·
Last Date of Registration – 24th JANUARY 2015
·
Issue of certificate with 4 credit hours
·
No refund against cancellation
·
Number of Registrations will be limited to 40
·
First come will have first preference
Category
Registration Fee
Spot Registration
All health care professionals -Medical/Ayurveda/
Pharmacy/Life sciences
Rs. 1750.00
Rs. 2000.00
Research scholars /All students – PGs, UGs etc.
Rs. 1500.00
Rs. 1750.00
Payment details – Registration Fee to be paid as
If Payment through DD/Cheque:
DD/Cheque in favor of: RajaRajeswari Medical College & Hospital
If Payment through NEFT:
Department of Central Research Laboratory
College Name: RajaRajeswari Medical College & Hospital
Kotak Mahindra Bank, A/C No: 6811260695, IFSC Code: KKBK0000427, MICR CODE:560485007
Please confirm your registration after mailing your NEFT details and xerox copy of DD/Cheque to:
[email protected]
Dr. S. Prabhakara
Central Research Lab
RajaRajeswari Medical College & Hosp
Bangalore – 74
M – 9482521675, 9008207528