REGISTRATION FORM
47th ANNUAL CONFERENCE OF U.P.STATE OPHTHALMOLOGICAL SOCIETY
NOVEMBER 17TH & 18TH ,ALIGARH
ORGANISED UNDER THE AEGIS OF ALIGARH OPHTHALMOLOGICAL SOCIETY
NAME:- ……………………………………………………………………………………………………………………………………
ASSOCIATE DELEGATE:- ……………………………………………………………………………………………………………..
ADDRESS:- ………………………………………………………………………………………………………………………………..
PIN CODE:-………………………………………
EMAIL:-……………………………………………………….
PHONE(WITH STD CODE):-……………………………..
MOBILE:-……………………………………………
MEMBER UPSOS(YES/NO):-………………………….....
MEMBERSHIP NO:- ……………………………….
EXPECTED TRAVEL PLAN:ACCOMODATION REQUEST:- PLEASE CONTACT :
PROF. MOHD ASHRAF: EMAIL: ashrafmddr@yahoo.com
MOB:- 09412397641
DR ANAND MOHAN: EMAIL: anandmohan72@rediffmail.com
MOB:-09837160183
ENCLOSED:- REGISTRATION FEE: Rs.
Demand draft/Multicity cheque no.:-
TOTAL Rs. IN WORDS
BANK:-
DATE:-
PAYABLE IN FAVOUR OF : ‘UPSOS OPHTHACON’ , Payable At Aligarh
REGISTRATION FEES
FOR OFFICE USE ONLY
RECEIPT NO:DATE:-
STATUS
DELEGATE MEMBER UPSOS
DELEGATE NON MEMBER
UPSOS
TRADE DELEGATE/PG
STUDENT/ASSOCIATE
DELEGATE
REGISTRATION NO:-
1. Postgraduate students must send certificate from their HODs
2. Spot Registration would not guarantee the registration kit
3. There is no refund on cancellation of registration
4. UPSOS members aged above 65 and their spouses are exempted from
registration fees
5. Entry to scientific sessions and trade exhibition areas is restricted to
registered delegates only.
BEFORE 30.09.12
Rs.1000
Rs.1500
Rs.750
BEFORE 30.10.12
Rs.1250
Rs. 1850
AFTER 30.10.12/SPOT
Rs.1500
Rs. 2250
Rs.900
Rs.1100
Mailing Address:PROF R R SUKUL
AMU Institute Of Ophthalmology, Gandhi Eye Hospital
Campus, Aligarh, U.P-202001
Ph:- 0571-2406455/2504576/2406301
Mob :- 09412272009
EMAIL:- rrshukul@rediffmail.com