26th Annual Conference of National Academy of Burns - India
NABICON 2018
Date : January : 19th - 21st, 2018 (18th January 2018 : Pre-conference VideoWorkshop & Nurses Programme)
Venue : Greenwood Resorts, Khanapara, Guwahati, Assam
Registration Form
Date: _ _ / _ _ / 201___
( Please fill in BLOCK letters)
Prof./ Dr./ Mr/Mrs/Ms:......................................................................................................................................................................................................
Job Title : ................................ Department: .......................... Hospital/Place of Work : .......................................................................................
Address for Correspondence:.......................................................................................................
.................................. ................................................................................Postcode :
Telephone No.:
Registration Fee Details (
Email...............................................................
tick the choice )
Type of Registration
Till 31st Sep.
Till 31st Nov.
Delegate
Rs 5000
Rs 5500
Rs 6500
Rs 7500
Overseas Delegate
USD 150
USD 200
USD 250
USD 300
Nurse / Paramedics
Rs 1500
Rs 1500
Rs 1500
Rs 2000
PG Students
Rs 2000
Rs 2000
Rs 2000
Rs 2500
Spouse & Children
above 12 years
Rs 1500
Rs 1500
Rs 2000
Rs 2500
Payment Details Cash
Till 31st Dec.
On Spot
Cheque / DD
Bank Transfer
Drawn on Bank ______________________
Cheque Number
drawn on __________________
(The Cheque/DD should be made in favor of NABICON 2018 payable at Guwahati)
Net Banking Transfer Details : Account Name : NABICON 2018 Current Account No. 36442154452
Bank : State Bank of India, Branch : GMCH, Bhangagarh,Guwahati-781005
IFS Code : SBIN0007700
Please send payment / Netbanking transaction details with completed registration form to us at the following address :-
Conference Secretariat
Ph : +91-94350-90162
Email : [email protected]
Dr. Poresh Boruah
Organizing Secretary, NABICON 2018
Office Room : Dept. of Plastic Surgery, GMCH, Guwahati-781032
Web : www.nabicon2018.org, Email : [email protected]
Signature
Cancellation Policy
All Cancellations for the conference registration form must be in writing and submitted to the
Conference Secretariat. Refunds shall be processed after the conference as per hereunder :
Before 15th October 2017 : 75% refund
Before 15 th November 2017 : 50% refund