CATEGORIES	UPTO 15/6/2014	UPTO 15/7/2014	SPOT
ASI MEMBERS	2750	3000	3250
NON ASI MEMBERS	3000	3250	3500
POST GRADUATE	1500	1750	2000
ACCOMPANYING PERSON	2250	2350	2450

Registration and Payment options are mentioned below:

Option 1: Pay by Bank Draft / Cheque

 

Download Registration Form

 

Option 2: Payment through NetBanking (NEFT)

 

Kindly make payment in favour of “TN&P ASICON2014”

Account details as follows:

Account Holder : TN&P ASICON2014

Bank Name: INDIAN OVERSEAS BANK

Branch : Anna Nager , Chennai

Account Number : 027002000006120 

IFSC Code : IOBA0000270

 

After making payment through NetBanking, fill-in the form below and submit.

 

Online Registration Form

 

Please Fill in CAPITAL LETTERS Only. All fields are required to be filled-in.

 

Personal Delegate Details:

Salutation:  : Prof. Dr. Mr. Mrs. Ms. Delegate Name: (As required on the certificate)  : Sex:                        Male       Female Age:    ASI Membership Number:  :

Address for Communication:

Address               : City  : State  : Pincode  : Country  : Select Here USA Canada India Afghanistan Albania Algeria Argentina Australia Austria Bangladesh Belgium Bolivia Bosna-Herzgvna Brazil Bulgaria Cambodia Chile China Colombia Costa Rica Croatia Cuba Cyprus Czech Rep. Denmark Doninican Rep. Ecuador Egypt Estonia Finland France Germany Greece Haiti Hong Kong Hungary Iceland Indonesia Iran Iraq Ireland Israel Italy Japan Jordan Korea Kuwait Latvai Lebanon Liechtenstein Lithuania Luxembourg Macau Macedonia Rep. Malaysia Mauritius Mexico Mongolia Nepal Netherlands New Zealand Nigeria Norway Pakistan Peru Poland Portugal Puerto Rico Romania Russia Saudi Arabia Sierra-Leone Singapore Slovakia Slovenia Somalia South Africa Spain Sri-Lanka Sweden Switzerland Syria Taiwan Thailand Turkey Ukraine United Kingdom Uruguay Venezuela Vietnam Yugoslavia Zambia Zimbabwe Other

Phone No (with STD Code ):

Office  : Residence           : Mobile  : Email     :

Payment Method: NEFT (Net Banking) For Online Payment you shall pay via your Online Internet Banking account ---> Login---->Fund Transfer---> Add Beneficiary--->Activate/confirm beneficiary----> make Payment----> get Transaction ID-->And enter this Transaction ID in this form. Enter NEFT Payment Transaction ID with Date: Total Amount (in Rs.):     Please refer to tariff chart above to ascertain your fee. (In Words Rupees)   Upload your Photo(passport size only) : Restrictions: Your photo should be a JPG or PNG file and less than 1MB only. Please wait for sometime after clicking submit for the photo to get uploaded. If you would like a confirmation email, please enter the characters you see in the image:

Please note

Registration fee for delegate includes kit, admission to scientific sessions, Trade exhibition, Inauguration function, lunches and banquet. PG Students must furnish documentary evidence (certificate from HOD) with the registration form. The organizing committee is not responsible for forms lost in transit. Delegate kit cannot be guaranteed for spot registration.

Cancellation and refund

Cancellation is permitted upto 15th July 2014 and 25% of registration fee would be deducted as processing charges. Refund of registration will be made only against a written request. Refund will be made 3 months after the conference.

Note: Further Communication will be sent only for registered delegates. Accommodation details visit:www.booking.com/chennaihotels To receive Tamilnadu Medical Council CME credit points certificates sent additional Rs. 100/- DD in favour of “TN&PASICON2014”. Payable at Chenai and mention your medical council registration number.

For Registration & further Details, Contact Conference Secretariat:

Dr.G. Chandrasekar

Organising Secretary- TN & P - ASICON 2014

Speed Medical Centre Hospitals

No. 527, Poonamallee High Road, Arumbakkam,

Chennai- 600106.

Phone : 044 23638131,23638141

Email : tnpasicon14@gmail.com

Mobile : 9884323595 / 9444070583 / 9841007181 / 9444083330