Professional Documents
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Registration Details
Registration Form
Upto 15th 16th June to 1st Aug to 30th 1st October 2010
June, 2010 31st July, 2010 September, 2010 onwards and Spot To be filled in capital letters
Member of INACO Rs. 1,000/- Rs. 1,150/- Rs. 1,350/- Rs. 2,000/-
Spouse of Members Rs. 800/- Rs. 1000/- Rs. 1200/- Rs.1500/-
Non Member Medical Rs. 1.725/- Rs. 1.950/- Rs. 3,000/-
Name : .....................................................................................................................
Rs. 1.500/-
Spouse of Non Member Medical Rs. 1300/- Rs. 1500/- Rs. 1700/- Rs. 2800/-
( As it should appear in the certificate of participation )
Non Member Non Medical Rs. 2300/- Rs. 2500/- Rs. 2700/- Rs. 3800/-
Spouse of Non Member Non Medical Rs. 3300/- Rs. 3500/- Rs. 3700/- Rs. 4800/- Age : ....................... / ................ Sex : ................... Nationality : ............................
Resident Delegates Rs. 800/- Rs. 1000/- Rs. 1200/- Rs. 1500/-
Address : .................................................................................................................
Foreign Delegates 100 $ (US) 150 $ (US) 200 $ (US) 250 $ (US)
.................................................................................................................................
l Registration without late fees is till 15th June 2010
l Children below 8 years of age are free from registration. .................................................................................................................................
l Registration fee for delegates / Resident delegates include: Delegate Kit, admission to the Scientific
Sessions, Trade Exhibition, Inaugural Function, Lunches and Dinners.
Discipline of work : ..................................................................................................
l Residents must furnish documentary evidence (Letter from the Head of the Department) along with the
registration form.
l The Secretariat does not accept liability for forms lost in transit.
Phone (with STD code) : Res. : .................................... Off :..................................
Mode of payment:
Mob. : .....................................................................................................................
All payments must be made by a Demand Draft in favour of:
“INACO KOLKATA CONFERENCE”
E-mail : ...................................................................................................................
Payable at 'Tamluk' and sent by post to:
The Conference Secretariat:
Dr. Swapan Kr. Samanta, 267, Abasbari, Tamluk, Medinipur (East), Whether a Member of INACO : .................................... Yes .............................No.
Indian Association of Community Ophthalmology ( INACO )
West Bengal, 721636, India, Tel/Fax (91)3228 266101, Mob: 9434023759
[www.incomoph.org]
swapansamanta53@gmail.com If Yes, Membership No. of INACO : ........................................................................
(No cheques will be accepted)
Foreign nationals have to pay in US Dollar.
Details of Accompanying persons : Name and Type of Delegate. Prou dly announces
Remember to mention on top of the envelope 'Registration Form for INACO Conference Kolkata' 1st International Annual Meet of Indian Association of Community
1. ............................................................................................................................
Ophthalmology & International Symposium on Community
PAYMENT DETAILS 2. ............................................................................................................................
Ophthalmology
(Please fill in capital letters)
Veg..... Non-Veg......Date of Arrival........................Date of Departure....................
Rupees (in words) .................................................................................................................
Mention if applied for Travel Support / Complimentary Accommod........................
Theme
DD No. ...................................................................... Dated ................................................. “Comprehensive Eye Care with Equal Rights and Excellence”
Mention if presenting Proffered Paper / Video / Poster .......................................
Drawn on Bank .....................................................................................................................
Check list for submission with registration from 30th & 31st October, 2010, Saturday & Sunday
Presenting Paper : Yes / No / Submitted.
Demand Draft. Age Proof and Student’s Certificate (if required)
Abstract Submission
Kolkata , West Bengal
Cancellation and Refunds
Use separate Plain paper for abstract.
Refunds will be made after the conference is over.
Abstract should be within 250 words which include : Title,
Refund limited to 25% of registration fee on or before 30th September, 2010. name of the authors, presenting author’s full address, aims & objects,
Refund requests will not be entertained after 30th September, 2010. materials and methods, observation and conclusion.
Important Dates
Last Date of Submission of Abstract 30th June, 2010. If required the Brochure (including the Registration Form
Last Date for early Registration 15th June, 2010. may be photocopied or downloaded from the website
Registration before 1st October, 2010 to avoid spot registration. www.incomoph.org