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Registration  Form

               Name:-______________________________________________________
 
               Department:-_________________________________________________

               Institute/College:-______________________________________________

               ___________________________________________________________

               City:-_______________________________________________________

               Telephone:___________________________________________________

               Fax:________________________________________________________

               E-Mail:-_____________________________________________________  

               Details of Payment_____________________________________________

               Registration Fee - Rs.800/- (Rs.400/- for students on production of certificate from the head of department )
               DD/Cheque payable at Delhi should be  send in favor of ‘TDM-2007’.
               (Payment includes Conference Kit, Tea, Lunches & Dinner)
 
Accommodation
               Budget accommodation for a limited number of participants on request. Payment has to be made in advance for the
               same (request before 10th Jan’2007)
Address for Correspondence
Dr KH Reeta
Organizing Secretary, TDM-2007
Assistant Professor,
Dept. of Pharmacology,
 AIIMS, New Delhi:-29
reetakh@gmail.com
Tel: 9891155703
(Photocopy of form is acceptable)