PERSONAL DETAILS

First Name
Last Name
Age
Sex
Institution
Name of the HOD

Residential Address
Pincode
Phone (Office)
Mobile
Email

WILLINGNESS TO PRESENT CASE/VIVA & SPOTTERS

I am willing to present the case for Cardiology Update in Clinics

I am willing to participate in Viva and Spotters

Prizes will be given for the best Case Presentation, Quiz, Viva & Spotters

PAYMENT DETAILS (Please select any of the below option and register)

Advance Registration by Demand Draft Fee 2000/- (Last date for Registration is 05/03/2019)

Demand Draft to be drawn in the name of "Care Your Heart Charitable Trust" payable at Chennai and sent to the address mentioned below.

Cheques will not be accepted.

PLEASE SEND THE DD TO THE FOLLOWING ADDRESS	FOR MORE DETAILS PLEASE CONTACT
Ms. Sini D Conference Secretary SIMS (SRM Institue of Cardiac Science) No.1, Jawaharlal Nehru Salai 100 ft road, Vadapalani, Chennai 600 026, India. Mobile: 8939810920 / 9677760919 Email: cardiologyupdateinclinics@gmail.com	Dr. G.N. Prasad, MD, DNB (Cardiology) Course Director & Organizing Secretary Mobile: 09444003696 Email: cardiologypgupdate@gmail.com	Dr. M. Ramesh Kumar Treasurer Mobile: 09840492220

DD No
Amount
Date
Bank Name
Place of issue

Advance Registration by Bank Transfer Fee 2000/- (Last date for Registration is 05/03/2019)

Spot Registration Fee 3000/-

Credit Card / Debit Card /Cheques will not be accepted

Free accommodation for Out-Station Delegates only (from 7th Mar. 6.00 pm to 10th Mar. 9.00 am) at Hotel Bhimaas.
Complimentary Breakfast at Hotel Bhimaas & Lunch at the venue. Dinner not included.

I need accommodation
I do not need accommodation

Date and time of arrival in Chennai