Neurology Update Mumbai 2016 19th – 21st February 2016, Hotel JW Marriott Mumbai Sahar, IA Project Road, Chhatrapati Shivaji International Airport, Andheri, Mumbai. Registration Form (Please fill in CAPITAL Letters) Name : _______________________ ____________________________ ________________________ First Middle Last Mailing Address : _____________________________________________________________________ City : ______________________________ Pin : _________________ State : ______________________ Medical Council No. _________________________ Tel. (with STD code) __________________________ E-mail : ________________________________________ Mobile No.: ___________________________ REGISTRATION : Consultant Resident / PG Student Upto 31st Oct. 2015 From 1st Nov. 2015 to 31st Dec. 2015 From 1st Jan. 2016 to 1st Feb. 2016 5,700 7,980 10,260 5,000 + 700* 7,000 + 980* 9,000 + 1260* 3,990 5,700 7,980 3,500 + 490* 5,000 + 700* 7,000 + 980* * 14% Service Tax NOTE :  NO SPOT REGISTRATION  Resident / PG Students must submit a bonafide certificate from HOD/Institute  For Online Registrations - All the Remittance / Transaction charges are to be borne by the Registrant. INCLUSIONS :  3 Lunches, 1 Dinner, Tea / Snacks & Conference Material.  Taxes PAYMENT :  To pay online via credit/debit card log on to “www.neurologyupdatemumbai.com”  Cheque/ DD, payable to “Neurology Update Mumbai 2016” Cheque/DD No. _____________________________ for Rs. _____________________________ Drawn on ______________________________________________________ Payable at Mumbai Add Rs. 100 for outstation cheques (not required for at par cheques).  Bank Transfer : A/c No. 50100100918100; HDFC Bank, Sandoz House Branch, Dr. A. B. Road, Worli, Mumbai – 400018. RTGS/IFSC Code : HDFC0000240 ________________________________ Signature For any assistance kindly contact CONFERENCE SECRETARIAT : FTC Events, M-33, Cusrow Baug, S. B. S. Road, Colaba, Mumbai – 400 039 Tel.: +91 22 2282 5108 Email – [email protected]