| 20th Annual Conference of Chandigarh Ophthalmological Society | ||
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| Registration Form | ||
| Name:___________________________________________ | ||
| Insitiutional Affiliation/ Address:________________________ | ||
| _______________________________________________ | ||
| Status: Delegate____ Associate Delegate_______ Resident____ | ||
| Enclosed Fee: _____________________________________ | ||
| By Cash/Demand Draft/Local Cheque no. _________________ | ||
| Dated ________ Drawn on Bank_______________________ | ||
| In Favor of: "Chandigarh Ophthalmological Society" Payable at Chandigarh. | ||
| Registration Fee: Rs. 200 only | ||
| Mailing Address: Dr. Sudesh K. Arya Organizing Secretary, COS Conference #1155-A Sector 32B, Chandigarh 160030 email: aryasudesh@yahoo.com |
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| For Office Use only Amt Rs. _________ Receipt No. __________ Regn. No. _________ |
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