Section A : Registration Form
                  

1.   Title:                       Prof. Dr. Mr. Mrs. Ms.

2.   Name *:               

3.   Designation *:      

4.   Affiliation/Organization/Institution* :  

5.   Mailing Address *: 

6.   City :                     

7.   Code :                    

8.   Country :                

9.   Phone *:   International Code     Area Code   Phone No.

10. Fax No. :  International Code     Area Code   Phone No.

11. E-Mail *:               

12. Accompanying Person 1:

13. Accompanying Person 2:

Payment Details

Charges Applicable

1.   Total Delegate Registration Fees * :             INR  

2.   Total Amount Payable (ACCOMMODATION) INR  

                            Grand Total Amount Payable*  INR  

Bank Draft/Demand Draft/Pay Order in favour of "Sleepmed2005"

payable at Delhi     No.   *     Dated:  *