BMCRI-ENT-DEPARTMENT

NAME;

SEX:  Male/Female                              AGE:

ADDRESS:

 

 

 TEL NO:                                                         MOBILE:

E-mail:

 

PAYMENT DETAILS:

(BANK/BRANCH/DD.NO/DATE DRAWN)

DD NO:                                                                                      DRAWN ON:                   

BANK:                                                                                        DATED:

 

 NOTE:

• P.G s SHOULD ENCLOSE BONAFIDE CERTIFICATE FROM HEAD OF DEPARTMENT.
• PAYMENT TO BE MADE BY DD/LOCAL CHEQUE/CASH
• DD TO BE DRAWN IN FAVOUR  OF    ‘BMC-ENTCME ‘ PAYABLE AT BANGALORE AND SENT TO CONFERENCE SECRETARIAT ALONG WITH REGISTRATION FORM                         
• EARLY BIRD REGISTRATION BY 10-04-2010.

                                              CONSULTANTS -              Rs 1500

                                              POSTGRADUATES –            Rs 1000

Note: Completed registration form along with the DD to be sent to

PROF AND HOD(ENT), BMC &RI, SRI VENKATESHWARA ENT   INSTITUTE, FORT, BANGALORE  560002