THADIKONDA SYMPOSIUM
L V Prasad Eye Institute
Cornea & Refractive Surgery
REGISTRATION FORM
Registration Fee for the meeting:
Up to 31st May 2017
1500/- INR
After 31th May 2017
2000/- INR
THADIKONDA SYMPOSIUM
JAM - Cornea and Refractive Surgery Meet
L V Prasad Eye Institute, GMR Varalakshmi Campus, Visakhapatnam, Andhra Pradesh
Name: ........................................................................................................................................................
I am a : Practicing Cataract, Cornea and Refractive surgeon
 Post graduate student/ fellow
Postal address: ........................................................................................................................................
.....................................................................................................................................................................
...................................................................................................... State: ..................................................
Email id: .................................................................... Mobile No: .........................................................
Authorizing signature: ...........................................................................
Bank Details for NEFT:
Account Name :HYDERABAD EYE INSTITUTE Account Number:0031104000250535
Bank Nname
:IDBI Bank Bank Branch
:Siripuram branch, Visakhapatnam Send the scanned PDF/
photo image of this registration
IFSC Code
:IBKL0000031
form to [email protected]
Account Type
:Saving Chief Organizer
Dr Merle Fernandes
Cornea and Anterior Segment Services
L V Prasad Eye Institute,
GMR Varalakshmi Campus,
Hanumanthwaka Junction,
Visakhapatnam, Andhra Pradesh.
Mobile: +91 9347033402
Phone: +91 0891 3984222
Email: [email protected]
Organizing Secretary
Dr Sayali Sane
Cornea and Anterior Segment Services
L V Prasad Eye Institute,
GMR Varalakshmi Campus
Visakhapatnam, Andhra Pradesh
Mobile: +91 9505070621
Phone: +91 0891 3984000
Email: [email protected]
Administrator
Mr Lokesh
L V Prasad Eye Institute,
GMR Varalakshmi Campus
Mobile: +91 9396612020
Email: [email protected]