REGISTRATION FORM
Dear Sir/Madam,

Kindly register me for the 8th National Conference of the IDPD

Signature

Registration Fee Doctors: Rs.500.00
Students: Rs.100.00

Please make a Demand Draft in favour of Indian Doctors for Peace and Development (IDPD) payable at Ludhiana.

Title : Dr Ms Mrs Mr
First Name ...............................................
Last Name ................................................
Designation................................................
Institution .................................................
..................................................................
Address.....................................................
..................................................................
City ..........................................................
Pin ................... State ..............................
Phone : ....................................................
Fax :.......................................................
Email :.......................................................

ACCOMMODATION
Hotel tariffs are mentioned over leaf.
The organising committee will facilitate in hotel bookings; for that kindly mention below
Kindly book accommodation for me:
Name of the Hotel :
Occupancy : Single/Double
From Date.................... Time....................
To Date................... Time...................
Note : Kindly mention if you are a couple.
Important:
Only the students will be provided with free accommodation from 29th Jan to 1st Feb Morning at Youth Hostel, Sanjay Place, M.G.Road, Agra, Phone: +91 0562 2354462.
Registration form must reach us by 15th January 2010