Please print and send the completed registration form to the address of the organizing secretary.

( Last date of submission of form is - 30.8.2002 )

INDIAN ASSOCIATION OF MEDICAL MICROBIOLOGISTS
VIII MAHARASHTRA STATE CHAPTER CONFERENCE
28TH AND 29TH SEPTEMBER 2002
PRE-CONFERENCE CME- 27TH SEPTEMBER 2002
Registration Form
Name and Qualification:_________________________________________________________________________
Designation:___________________________________________________________________________________
Institution: ____________________________________________________________________________________
Mailing Adress: ________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
Tel No. with STD code ( O ):______________________________ (R):____________________________________
E.mail address : _______________________________________________________________________________
Food preferences : Veg Non-veg.
Registration for (please tick appropriate boxes)
Category Up to 30th August, 2002 Spot registration CME Conference Conference Delegate Rs.500 Rs. 1,000 Rs. 1300 Associate delegate - Rs. 900 Rs. 1000 P.G student (bonafide) Rs.500 Rs. 700 Rs. 900
Accommodation
( Click here for details)
The organizing committee will assist the delegates in their accommodation provided the request for accommodation reaches the secretariat by 31.7.2002 and advance amount equal to the actual cost as per table given along with the completed accommodation form is sent along with.
Number of rooms required :	Single	Double
	A.C	Non A.C
Dates for hotel accommodation : From ________________________________ to ____________________________
Choice of hotel :	1st choice : _____________________________________________________________ 2nd choice : ____________________________________________________________
Details of the amount sent :
1. Registration fees:	CME : Rs.______________________________________________________________ Conference : Rs._________________________________________________________
2. Associate delegate : Rs._________________________________________________________________________
3. Accommodation : Rs.___________________________________________________________________________
Total : Rs._______________________________________________________________________________________
CASH/ D.D NO _______________________________		Drawn on Bank ______________________________________
Branch_______________________________________		Dated ______________________________________________
Payment should be made A/c payee in favour of "8th MHC IAMM", payable at Mumbai.
Date : __________________________________________ Signature : _____________________________________
Mail to: Organizing Secretary Dr. Preeti R Mehta Professor and Head Department of Microbiology 7th floor, Multi Storeyed Building, K.E.M Hospital, Parel, Mumbai - 400012 Tel: 4164372, 4136051 Ext-2039/2552 E-mail: kem_micro@vsnl.net
Note: For IAMM members above 65 years of age, there will be no registration fees. P.G students should send bonafide certificate along with their registration form. Cancellation of registration is allowed only if request for cancellation is received before 10th September, 2002. Only 50% of the registration fees will be refunded.