REGISTRATION FEE

Category IAP Member Non-IAP Member * PG Student * Sr. Citizen (above 70 Yrs., IAP Members only) SAARC Delegate Accompanying Delegate (India & SAARC) Accompanying Delegate (Foreign) *Sr. Citizen (between 65-70 Yrs., IAP Members only) Foreign Delegate Trade Delegate Refund Cancellation Accompaying Child (above 110cm till 18 yrs) 01 Feb. - 15 May 2011 INR 6500 INR 7500 INR INR 7500 INR 6500 $ 700 INR 4500 $ 700 INR 8000 75% INR May - 31 July 2011 INR 7500 INR 9000 INR INR 9000 INR 7500 $ 750 INR 6000 $ 750 INR 10000 50% INR Aug. - 30 Sep. 2011 INR 10000 INR 11000 INR INR 11000 INR 10000 $ 850 INR 7000 $ 850 INR 12000 25% INR Oct. 2011 - 30 Nov. 2011 INR 12000 INR 14000 INR 8500 INR 8500 INR 14000 INR 12000 $ 1000 INR 8500 $ 1000 INR 15000 NIL INR 4000
Note : Workshop Fee : INR 1000 each for indian delegates, INR 2000 each for SAARC delegates and USD 100 for International delegates not be ensured. * Valid Certificate to be produced.
Spot Registration : INR 1500 + Last Slab. Delegate Kit can

MODE OF PAYMENT:

BANK DETAILS Kotak Mahindra Bank Ltd Swift : KKBKINBBCPC Account No : IFSC/NEFT Code : KKBK 0000261 In Favor of : PEDICON 2012 DEMAND DRAFT In Favor of : PEDICON 2012 Payable at Gurgaon, India
ONLINE Online registration & payment shall be activated soon. Please check www.pedicon2012.com for further updates CONFERENCE SECRETARIAT : Dr. Mahavir P. Jain Organizing Secretary Nova Care Clinic, Jacobpura, New Railway Road, Gurgaon 122001 (Haryana) Mob. : +91 8826495303; 8826495304; Phone : +4274651/52; Fax : +4274653 E-mail : info@pedicon2012.com; registration@pedicon2012.com Web : www.pedicon2012.com

PEDICON 2012

G u r g a o n
49th Annual National Conference Of IAP
18 - 22 January 2012, Leisure Valley Grounds, Sector - 29, Gurgaon Host : IAP Gurgaon Branch
Nurture with Theme Care REGISTRATIN FORM
(Please fill the form in CAPITAL letters only)

IAP Member ship No...

Name :...... First Middle Last
Designation :... Institute :...... Address :......... City :... State :... Country :... Zip Code :.. Mobile :... Tel. (Office) :... Tel. (Residence) :... Fax :..... Email :..... CATEGORY IAP Member Non IAP Member PG Student Sr. Citizen above 70 years (IAP Members only) SAARC Delegate Accompanying Delegate (India & SAARC) Accompanying Delegate (Foreign) Sr. Citizen (between 65-70 Yrs., IAP Members only) Foreign Delegate Trade Delegate MEAL OPTIONS VEG NON-VEG JAIN REGISTER ME FOR CONFERENCE

REGISTER ME FOR WORKSHOP

RESIDENTIAL DELEGATE SCHEME AVAILABLE (Delegate Fee + Taxi + Stay in 4/5 Star Hotel + Local Travel): For More Information Please Contact Conference Secretariat PLEASE ALSO REGISTER MY ACCOMPANYING PERSONS / DELEGATES
01 :..... 02 :..... 03 :..... 04 :..... Total Amount :... (In Words) :...... I AM PAYING THE ABOVE AMOUNT BY FOLLOWING MODE Bank Transfer : Transaction Ref. No :..... Dated :.. Online : Transaction Ref. No :...... Dated :.. Demand Draft : DD No. :... Drawn on :.... Dated :..
* this member contribution includes Rs. 1000 for central Indian Academy of Pediatrics corpus fund also. CONFERENCE SECRETARIAT : Dr. Mahavir P. Jain - Organizing Secretary Nova Care Clinic, Jacobpura, New Railway Road, Gurgaon 122001 (Haryana) Mob. : +91 8826495303; 8826495304 Phone : +4274651/52; Fax : +4274653 E-mail : info@pedicon2012.com; registration@pedicon2012.com Web : www.pedicon2012.com

*Fields are Mandatory

Signature :.. Dated :..