RBF Symposium

For off-line registration Download Registration Form

Applicant's Detail

Initials

Last Name

First Name

Middle Name

Affiliation

Address 1

Address 2

City

Zip/Pin Code

Country

Phone

Fax

E-mail

Accompanying Spouse Name

Presenting Poster

Payment Details

Foreign Delegates (Rest of the world)
		Registration till Dec 31, 2008
Industry		300 USD
Academics		250 USD
Student*		150 USD
Accompanying Spouse		150 USD

Delegates (India & Other SAARC Nations)

Industry

Rs. 8,000

Academics

Rs. 5,000

Student*

Rs. 3,000

Accompanying Spouse

Rs. 2,500

*Proof of identity required

Total Amount Payable

Mode of Payment

Cheque / Draft Details

Banker's Cheque / Draft No.

Bank Name, Branch

Amount

Banker's Cheque / Draft Dated

Note: Banker's Cheque / DD should be drawn in favour of "Ramanbhai Foundation " payable at Ahmedabad, India
Personal Cheques are not acceptable.

Registration will be confirmed only on the receipt of the registration fee. Demand Draft or Banker's Cheque should reach the undersigned within 7 days from the date of online registration.

Dr. Mukul R. Jain
Zydus Research Centre
Sarkhej-Bavla NH# 8A
Moraiya
Ahmedabad 382210
(Gujarat) India
TEL: +91-2717-250801
FAX: +91-2717-250606
E-mail: registration@rbfsymposium.net