Registration Form

Registration Form

Name
Address
City
Pincode
State
Country
Phone
Mobile
E-mail
Fax
Designation
Registration Fee
Banquet
Hotel Tariff
Total
DD.No. Dated
Bank
	Hotel Registration * 3 Nights & 4 days Special Conference package ( with Breakfast)
	1) HOTEL CIDADE DE GOA	Press 'Y' in relevant box
	* Rs. 10,500/-(USD $ 175 ) incl.taxes per person ( on twin sharing basis)
	* Rs. 19,350/-(USD $ 325) incl.taxes - single occupancy
	* Extra Child betwwen 6 to 12 yrs - Rs. 4500/- (USD $75) incl.taxes
	20 Persons group pickup & drop-Airport/Railway Station. Access to all recreational facilities.

	2) HOTEL INTERNATIONAL CENTER GOA. (Dona Paula)
	* Rs. 4500/- (USD $ 75) incl Taxes- per person ( on twin sharing basis)
	* Extra adult (only one) Rs. 3500/- (USD $ 60) incl. taxes with breakfast
	* Extra child (only one) between 6-12 yrs. Rs. 2000/- (USD $ 35) incl. taxes with breakfast
	Access to all recreatinal facilities.
	(Please add separate conference fees to hotel tariff before sending final amount )

(Name of prefered twin sharing person )
	Payment : 1) By Cash / D.D./ Cheque drawn if favour of "ILIZAROV COURSE" payable at Solapur to Organising Secretary. 2) By electronic transfer ( for details contact Org. Secretary.) Electronic transfer slip to be attached with Registration form. fro more details. 3) All future communication by email,SMS & updates / details will be on website only.