REGISTRATION FORM

REGISTRATION FORM
(Registration fees Rs. 200/- on the spot)

Name (in block letters) : …………………………………………………………….

Designation & place of posting :…………………………………………………..

Complete address &:………………………………………………….
……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………… e-mail address:…………………………………………………………………………………

Phone No. Office-: Res:

Veg./Non Veg.

Presenting free papers or not. If yes, please send the extract of the paper before 10th August ’07 by e-mail at drathaur2006@gmail.com or drsengupta2002@gmail.com and hard copy by date before 15th Aug.’07.

Return reservation confirmed or wait listed. In case of wait listed, please mention -
PNR No. with train No. -
Date of departure -
From / To -
Class -

Date of arrival with train No. & railway station: …………………………………..
Any publication in any Scientific Journal of anaesthesia between April’06 to March’07 should be sent to Dr. A. Prakash, Sr.DMO (Anaes), Northern Railway Central Hospital, New Delhi for “Miss. Shilpi Anand Memorial best paper award”.

Note: It will be appreciated if you confirm your arrival by 31st August ’07. Transport will be available on 8th & 9th Sept. ’07 at Asansol & Chittaranjan stations on arrival by morning trains. For further enquiries please contact the following:
Dr. S.S.Rathaur, CMS-CLW, Phone- (0341)2525536(O), 2525535 (R), Mob. 09434758140.
Dr. Alok Majumdar, Sr.DMO (G), CLW – Phone- (0341)22526648(O) & 2526649 (R)
Dr. Saikat Sengupta, DMO (Anaes)/CLW – Mob. 09831706844