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› Profile of Guest of Honour.

 
Register Online

Secretariat & Host Address :


Dr. K S Santhan Gopal,
# 81, 1st Floor, 7th Cross,
4th Block, Koramangala,
Bangalore - 560 034,
Karnataka, India
Ph No. : 080 – 25526944,
Mobile : 9844110288/9448043140,
Fax : 080 – 25526944

I. PERSONAL DETAILS (Please type or print clearly and include all Information)
1. AIOS Member   Yes   No
  AIOS Membership Number  
2. Senior Citizen (age > 65)   Yes   No
  Physical Handicap   Yes   No
3. Full Name  
4. Gender   Male   Female
5. Title   Dr.   Prof.   Mr.   Ms.
6. Age    
7. Qualifications   MD   MS   DNB   DO
      FRCS   PHD   MBBS   Others
8. Affiliation  
  Name of the Hospital / Laboratory / University / Company, City
9. Mailing Address  
  City  
  Pin Code  
  State  
  Country  
10. Mobile No.  
11. Telephone No.  
       countrycode - citycode - number
12. Fax No.  
       countrycode - citycode - number
13. Email Address  
14. Accommodation Required   Yes   No
II. REGISTRATION DETAILS
15.  
  Category   Early Bird Registration
( Valid up to 31st Oct, 2007)
  AIOS Member  Rs 2100 ( US $ 55) 
  Non Member  Rs 3150 ( US $ 85) 
  Resident Rs 1575 ( US $ 45) 
  Guest Delegate Rs 1575 ( US $ 45) 
  Trade Delegate Rs 3150 ( US $ 85) 
 
III. CANCELLATION POLICY
 All cancellations with request for refunds must be received by us (conference secretariat) in writing latest by December 31st, 2007. Cancellation charges will include 10% penalty until October 31st, 2007. 25% penalty until November 30th, 2007. 50% penalty until December 31st, 2007. And no refund after December 31st, 2007. All refunds shall be settled after the conference in 2008.
   
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