Registration Details                              

 Registration                             Till 26th August            Spot

Indian Delegate                              Rs. 1500               Rs. 2500

Foreign Delegate                            USD 100               USD 150

SAARC Countries Delegate           INR 2000              INR 3000

Accompanying Person                   Rs. 1000               Rs. 1500

Nurses/ Paramedics                       Rs. 500                 Rs. 750

Residents/ Med. students               Rs. 750                 Rs. 1000

Academic Council Delegates          Rs. 1250              

                                    REGISTRATION FORM 

Name:___________________________________________________

Email: ___________________________________________________

Institution:  _______________________________________________

Designation:  Circle one

1.     Faculty 

2.     Resident                             

3.     Student

4.     Nurse

5.     Paramedic Indian Delegate

6.     Physician/ Surgeon

7.     Nominated Councilor

8.     SAARC Country Delegate   

9.     Foreign Delegate

Name: ___________________________________________________

Postal Mailing Contact: (Mandatory)

Name____________________________________________________

Address:__________________________________________________

Phone:___________________________________________________

I have Read the Rules and will abide by them.

I have attached a DD/Check for Rs____________________

In favor of INDUS-EM 2006.

Signature:________________________________________________

COUNCILOR  NOMINATION FORM

Name of Nominated Faculty:_________________________________

Faculty Position:  __________________________________________

Medical College:___________________________________________

Department: ______________________________________________

Address: _________________________________________________

_________________________________________________________

Phone:___________________________________________________

Mailing Address:  __________________________________________

_________________________________________________________

Phone at Home:  ___________________________________________

Email: (mandatory)_________________________________________

I have read the objectives and expectations of the Position of Nominated Councilor on the INDUS-EM Academic Council of 2006-2007. I agree with the requirements. I have attached the needed documents. 

Check List: (Circle the Needed) (All need to be circled)

1.     Completed Registration Form                           

2.     Completed Nomination Form

3.     Dean's Support Letter         

4.     Curriculum Vitae

5.     Registration Fees

6.     Superintendent's support letter

7.     Passport size Picture

Signature:_____________________________________________

      Click here to download Registration Form in PDF format