ORG. SECRETARY'S DESK ABOUT IDA ORGANISING COMMITTEE ABOUT ALLAHABAD
TENTATIVE PROGRAM MEMBER REGISTRATION FORM PAPER ABSTRACT FORM
LIST OF HOTELS
 
REGISTRATION FORM
*All fields are Required.

Name :

Spouse Name :

Designation :
Address :

Email ID(Optional) :

Phone : Office :
Residence :
Mobile :
Payment Mode : In favour of "29th U.P. State Dental Conference 2004" Payable at Allahabad
Amount Rs.
In words
D/D/Cheque No.
Date
Bank/Branch
Out station cheque include additional amount (Rs. 50) Fifty
Please Mail To : Dr. Vinod Kumar Singh
Ph : (Cl)0532-22653530
        (M)941 5156522		 Address Dental & Oral Care Point
1, Choudhary Garden Market
Kalyani Devi, Allahahabd
Registration Details        
    Before 30th Sept. 04 After 30th Sept. 04
R. C. Member (With Hospitality) Rs. 1100 Rs. 1300
Spouse Rs. 900 Rs. 1000
Child(6-12Yrs.) Rs. 500 Rs. 600
Delegate(Without Hospitality & Gift) Rs. 500 Rs. 600
Student Delegate (With Hospitality) Rs. 500 Rs. 600
HOSTED BY :
INDIAN DENTAL ASSOCIATION
ALLAHABAD BRANCH
E-mail : upsdc2004@sahajdental.com
VENUE :
HOTEL ALLAHABAD REGENCY, 16, TASHKENT MARG, ALLAHABAD - 211001
PH. : 0532-2601519, 2601725