conference registration form (please fill in block … registration form1.pdf · 2.cancellation...

CONFERENCE REGISTRATION FORM

Title: Prof. Dr. Mr. Ms

Category: IHPBA Member Yes No IHPBA Membership No.

Non-Member Accompanying person PG Student* Foreign Delegate

*Certificate from Head of Department is mandatory for PG Student

*Name (to appear on certificate & badge)

Age Sex MCI State MCI No

Designation Institute

Address

City State Country Pin Code

*Mobile Tel. (0) *Email

Name of Accompanying Person (s)

(1) Name Relation Age/Sex/

(2) Name Relation Age/Sex/

Personal Details

(Please fill in BLOCK CAPITAL LETTERS)Field *Marks Are Mandatory

Registration Details

th17 Annual Conference of India Chapter of

International Hepato Pancreato Billiary Association

Registration Fee Includes:

1. Admission to Scientific Sessions & Exhibition, Refreshment during breaks, Lunches & Dinners, Registration Material & Kit, Participation Certificate.

2. For Accompanying Person - Refreshment during breaks, Lunches & Dinners, Registration Material

3. Conference kit is subject to availability for spot registration.

4. We will accept only cash or credit/Debit card for spot registration

Registration Cancellation & Refund Policy:

1.Cancellation on or before 30.11.19, 25% registration charges will be deducted.

2.Cancellation after 1.12.19 till 31.12.19, 50% of registration charges will be deducted.

3.No Cancellation or refund after 31.12.19.

4.Registration cancellation will be accepted only against the written request sent by email to ihpbaindia2020@gmail.com st before 31 December 2019.

The refund process will begin 15 days after the conference (Note: Application bank charges will not be refunded for online registration)

CATEGORYthTill 30 November 2019

st th1 December 2019 to 15 January 2020 Late & Spot

IHPBA Member INR 10000 INR 11000 INR 12000

Non Member INR 11500 INR 12500 INR 13500

P.G. Student* INR 5500 INR 6000 INR 7000

Accompanying Person INR 6000 INR 6500 INR 7000

Foreign Delegates USD 150 USD 175 USD 275

INDIA 2020IHPBA171717

TH

BHUBANESWAR

ANNUAL CONFERENCE OF INDIA CHAPTER OF INTERNATIONAL HEPATO PANCREATO BILLIARY ASSOCIATION

Conference SecretariatDr Mohammad Ibrarullah | Organizing SecretaryMobile: 9937377331Email: ihpbaindia2020@gmail.comWeb: www.ihpbaindia2020.com

Professional Conference Organizer56, Institutional Area, Sector - 44, Gurgaon-122002, Haryana, IndiaMr. Rohit Kamra Mob: +91 9818965679Email: projects1@meetingsnmore.com

INDIA 2020IHPBA171717

TH

BHUBANESWAR

ANNUAL CONFERENCE OF INDIA CHAPTER OF INTERNATIONAL HEPATO PANCREATO BILLIARY ASSOCIATION

th th24 - 26 January 2020 | Hotel Swosti Premium, Jayadev Vihar, Bhubaneswar

*All prices are inclusive of GST 18%

By demand draft/Multi city cheque/Bank Transfer (applicable only for Indian Delegate) in favor of "International Hepato Pancreato Biliary Association Bhubaneswar” Payable at Bhubaneswar.

Account Name - International Hepato Pancreato Biliary Association Bhubaneswar IFS Code - UTIB0000438 Account number – 918020067601334 MICR code – 751211004 Branch Code- 000438

Cheque / DD / NEFT / Transaction No Name of Bank

Account Holder Name Total Amount Transaction Date Signature

Discount on Early bird Registration.

Can be upgraded to residential package on request by adding the room rent.

Payment Details

Theme: HPB Surgery: Then and Now