isccp.inisccp.in/wp-content/uploads/2018/10/Registration-Form.docx · Web viewIndian Society of...
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Indian Society of Colposcopy & Cervical Pathology (ISCCP) & Obstetric and Gynaecological Society of Visakhapatnam (OGSV) In association with Homi Bhabha Cancer Hospital & Research Centre, Visakhapatnam A Grant in Aid Institution of the Department of Atomic Energy, Government of India ISCCP CONFERENCE 2019 Benchmarking Cervical Cancer Prevention & Screening 19, 20, 21 April 2019 VISAKHAPATNAM Registration Form Name ____________________________________________________________________ ___ Medical Council Number _________________________ State/UT ________________________ Address ____________________________________________________________________ ___ ____________________________________________________________________ ___________ Mobile ________________________ Email ___________________________________________ Category: ISCCP Member/Faculty Non-Member Post Graduate Student Are you presenting a paper? No Yes Oral Poster Are you attending a workshop? No Yes Topic: _____________________ (see below) Registration for Conference and Workshop are separate. Delegates for conference can choose to attend a workshop of their choice Registration Fee for Conference (20-21 April 2019) & Workshops: (Inclusive of GST) Category Early bird (31 Dec 2018) 1 Jan - 28 Feb 2019 Spot ISCCP Member/ Faculty 4000 4500 500 0
Transcript of isccp.inisccp.in/wp-content/uploads/2018/10/Registration-Form.docx · Web viewIndian Society of...
Indian Society of Colposcopy & Cervical Pathology (ISCCP) &Obstetric and Gynaecological Society of Visakhapatnam (OGSV)
In association withHomi Bhabha Cancer Hospital & Research Centre, Visakhapatnam
A Grant in Aid Institution of the Department of Atomic Energy, Government of IndiaISCCP CONFERENCE 2019
Benchmarking Cervical Cancer Prevention & Screening 19, 20, 21 April 2019 VISAKHAPATNAM
Registration Form
Name _______________________________________________________________________
Medical Council Number _________________________ State/UT ________________________
Address _______________________________________________________________________
_______________________________________________________________________________
Mobile ________________________ Email ___________________________________________
Category: ISCCP Member/Faculty Non-Member Post Graduate Student
Are you presenting a paper? No Yes Oral Poster
Are you attending a workshop? No Yes Topic: _____________________ (see below)
Registration for Conference and Workshop are separate. Delegates for conference can choose to attend a workshop of their choice
Registration Fee for Conference (20-21 April 2019) & Workshops: (Inclusive of GST)
Category Early bird (31 Dec 2018) 1 Jan - 28 Feb 2019 SpotISCCP Member/ Faculty 4000 4500 5000Non-Member 4500 5000 5500PG Student 3000 3500 4000Nurses/ UG Students 2500 3000 3500
Pre-congress Workshops (19 April 2019): (Inclusive of GST)
Topic Early bird (31 Dec 2018) 1 Jan - 28 Feb 2019Colposcopy (full day with lunch) 1500 2000Cytology & HPV Testing (morning session & lunch) 1500 2000Screen & treat (lunch and session) 1500 2000Cytology + Screen & Treat (with lunch) 2000 2500
Payment Methods:
1. Cheque or Demand Draft, favouring ISCCP 2019 Conference, payable at Visakhapatnam.2. Cash payment in person at the Secretariat along with the filled-in registration form.
3. NEFT/RTGS: Account Name: ISCCP 2019 Conference, Account Number: 174011100001848 IFSC Code: ANDB0001740 Account Type: Current Account. Bank: Andhra Bank, Aganampudi, Visakhapatnam.
Please share the NEFT/RTGS transfer details by email to [email protected]
Transaction number: __________________________________
Your bank name _____________________________ Branch________________________________
City/Town________________________ Your Account Number: _____________________________
Cancellation Policy: Written requests received before 28 February 2018 will be considered for a 50% refund of fee after the conference is concluded.
Address for correspondence: ISCCP 2019 Conference Secretariat, Homi Bhabha Cancer Hospital & Research Centre, APIIC Industrial Park, Aganampudi, Visakhapatnam 530 053 Andhra Pradesh.
Email: [email protected], [email protected]
