APCRICON 2015
4th & 5th July 2015, Hyderabad
REGISTRATION FORM ___________________
Name
Designation
Organization/Institution
Residential Address
Phone Numbers
Landline:
Mobile
Email Address
APCRI Membership Number
Name of the State Medical
Council
State Medical Council
Registration no.
Payment Details
DD no./UTR (Unique
Transaction reference no.)
Food Preference
∗
∗
∗
Vegetarian
Non Vegetarian
PG’s should enclose HoD’s permission letter
Spot registration: Conference bags and other material subject to availability
Name shall be written clearly in capital letters only with a space as separation. Please do not use running
hand. The name sent shall be printed on the certificate as per APMC requirements.
Corrections shall not be entertained.
Payment Options
1. Demand Draft to be sent by regd. post/courier in favor of “APCRI” to
Dr. V. Srinivasa Rao
Organizing Secretary, APCRICON 2015,
H. No: 3-44-132, Krishna Nagar colony,
Near Gandhian School, Picket, Secunderabad 500009.
Phone: 09848268980
2. Bank NEFT transfer in favor of “APCRI”
Account Number: 04872010025617, IFSC: SYNB0003032.
Syndicate Bank, Picket Branch, Secunderabad – 500 026.
Association for Prevention & Control of Rabies in India (APCRI)
Application for “Young Scientist Award 2015”
1. Name:_______________________________________________________________________________
2. Date of Birth & Age: _____________________________Yrs
3. Sex: ________________________
4. Institutional Address: ___________________________________________________________________
5. Qualification(s): _______________________________________________________________________
6. Present designation: ___________________________________________________________________
7. Phone No.s: (Office):__________________ (Res): ________________ Mobile: ___________________
8. Fax: ______________________
9. Email: ________________________________________________
10. Topic of research (s) work undertaken (enclose only details of work done in the field of rabies): _______
_____________________________________________________________________________________
11. Place & year during which research was undertaken: _________________________________________
12. Training undergone (relevant to rabies): ____________________________________________________
13. Total years of Experience: ___________
Teaching: ______________ Research: ________________
14. Awards/Medals/Fellowship received (enclose copies): _________________________________________
15. Total number of research papers published (relevant to rabies): _________________________________
National Journals: ________________________. International Journals: __________________________
16. Any other information in support of research work: ___________________________________________
(Signature of the applicant)
(Signature & Seal of
Head of the Department)
(Signature & Seal of the Head of the Institution)
th
Note: 1. Submit an attested copy of proof of your age (10 std. marks card/etc.)
2. Submit a copy of the research work done for claiming the award.
APCRI is inviting applications from eligible candidates for the annual young scientist awards in the field of rabies research.
Following are the guidelines for applying:
1.
2.
3.
The applicant can either be a Medical or Veterinary person with a post graduate degree or diploma.
st
Age of applicant should not be more than 40 years as on 1 July 2015.
Applicant with full details of the research work in the field of rabies should be submitted to Organizing Secretary,
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APCRI (in sealed cover) on or before 10 June through head of the institution where he/she has completed the
research work.
4. Research work(s) carried out as a project or a scheme or departmental research or P.G. researches are eligible
for consideration.
5. The research should have been carried out during the preceding 5 years.
6. The research should have been carried out in India.
7. Evidence of age (date of birth) should be enclosed along with the application.
8. Only life members of APCRI are eligible to apply for the award.
9. The Award committee of APCRI reserves the right to defer the award if suitable candidates are not available in
the particular year and the decision of the committee will be final.
10. The award carries a cash prize (paid of Demad Draft) of Rs. 5,000/- a citation & a certificate which will be given
during the conference.
11. One award will be given per year.
12. The young Scientist who applies & gets the award shall make the presentation of his/her work during the annual
conference of APCRI during the same year. He/she will be given Travel (2 tier AC train) fare & an amount of Rs.
3,000/- towards accommodation & incidentals.