Registration Form Name: First name: Institute/Hospital: Postal Address: City: Postal/Zip Code: Country: Email id: Tel. (with area code): Residence: Mobile (mandatory): Fax: Registration for: [ ] Conference only [ List of hotels for accommodation within 5kms of distance from conference venue Last name: Hotel State/Province: Contact No. ( code: +91-2692) Hotel Relax 267473, 242429 3rd floor, Hariba Vyapar Bhavan, GPO road, Anand Motel Sanvaria Regency 235090, 235091 Motelsanvaria2007yahoo.in 2nd floor, ”SHILP”, Opp. Bhaikaka statue, Vallabh Vidyanagar Hotel Surabhi Regency 242018, 242279, 242601, 254054 hotelsurabhiregencyyahoo.co.in Jay tower, Amul dairy road, Anand Hotel Favourite Regency 230884 Nr.Railway Crossing, Vallabh Vidyanagar Hotel Pooja Inernational 254253 Amul dairy road, Anand Hotel Laksh Residency 267897, 267898 [email protected] Laksh Prime, Opp town hall, Anand Hotel La Casa Inn 264801, 264802 [email protected] Near Ganesh Crossing, Anand-Sojitra road, Anand Hotel Rama Regency 266446, 266447 3rd floor,Shri Ram arcade, Old Gopal Cinema, Anand Madhubhan Resort 18002339009 [email protected] Anand Sojitra road, Anand Office: ] Conference and workshop [ ] Workshop only Registration Category: [ ] SCS Member [ ] SCS Non-member [ ] PG Student/Spine Fellow [ ] Medical Professional [ ] Paramedical Professional** (**Please encircle one Nurse/Psychologist/Social Worker/Parents/Other) All future communication through email and SMS Total amount to be paid for conference: (In words) Payment type: [ ] Online transfer • Transfer reference no: [ ] Demand draft • Name of bank: • Date of issue: Demand draft No: Registration fees for medical professionals: Categories Conference only Conference& workshop Workshop only Members 4000 5000 2000 Non members 5000 6000 2000 Fellow/PG student 2000 3000 1500 Registration fees for Physiotherapist and Occupational therapist: Categories Conference only Conference& workshop Workshop only Members 2000 3000 1500 Non members 2500 3500 1500 Fellow/PG student 1500 2000 1000 Registration fees for Paramedical professionals, Parents and consumers: Categories Conference only Conference& workshop Workshop only Members 1500 2000 1500 Non members 2000 2500 1500 Fellow/PG student 1500 2000 1000 Cancellation statement: Cancellation of participation received at conference office by 1st November 2014 will be accepted and all fees refunded less an administration fees of Rs.500/-. Cancellation received after 1st November 2014 will not be refunded. Address Please send your registration along with DD to: Dr. R. Harihara Prakash, Organising Chairperson ISSICON 2014 K. M. Patel Institute of Physiotherapy Shree Krishna Hospital, Karamsad- 388325, Gujarat, India Email: [email protected] | Phone:+91-2692-228281 Contact: Mr. Bakul Parmar Phone: +91-9714269886 Email: [email protected] SEND YOUR ABSTRACTS ON [email protected] For more details visit www.issicon2014.com 14th SCS Conference (ISSICON 2014) November 7 to 9, 2014 K. M. Patel Institute of Physiotherapy Shree Krishna Hospital, Karamsad, Gujarat. H M Patel Centre for Medical Care & Education ACCREDITED FOR: DIAGNOSTIC LABORATORIES • BLOOD BANK IMAGING SERVICES • HOSPITAL Pre-conference Workshop: November 7, 2014 Organized by : K.M. Patel Institute of Physiotherapy, Karamsad. www.charutarhealth.org Dear All, Residence of the Great Visionary Leader, Iron Man of India - Sardar Vallabhbhai Patel at Karamsad. (Distance from Conference Venue - 1 km) Heart of the city, Amul Dairy, Anand The largest food brand in India and largest Milk brand in World (Distance from Conference Venue - 7 km) Greetings from Karamsad, the land of Iron Man of India, Sardar Vallabhbhai Patel. K. M. Patel Institute of Physiotherapy, charutar Arogya Mandal, Karamsad takes pride in its eneavor towards quality with its achivement of being the first physiotherapy college in the country affileted to a medical college, to be accredited by National Assessment and Accreditation Council (NAAC) in the year 2013. It gives us great pleasure in inviting you to ISSICON 2014, which will be combined meeting of Spinal Cord Society and Asian Spinal Cord Network. The conference will be preceded by one day workshop on, “ comprehensive Care in SCI” which will be limited to few participants. Thus with great pleasure and pride, we at K. M. Patel Institute of Physiotherapy, Karamsad, invite and welcome you to the milk city of India, Anand, for enriching experience to International Conference ISSICON 2014. Famous Pilgrims Center, Grand Temple of shri Ranchod Raiji, Dakor. (Distance from Conference Venue - 44 km) Akshardham Swaminarayan Temple, Gandhinagar. (Distance from Conference Venue - 102 km) Organising Chairpersons Spine surgeons Orthopedicians Neuro Physicians Spinal cord injury Specialist/rehabilitation Physicians Physiotherapists Occupational therapists Psycologists Orthotists Nurses Social workers/counselors Neurologists/ Urologists/Pain Specialists Gatsroenterologists/Psychiatrists Consumer group Programme Schedule Day 1 Friday November 7, 2014 9:00am to 5:00pm Workshop Day 2 Saturday November 8, 2014 8:30am to 11:00am Plenary Session 11:00am to 5:00pm Conference 7:00pm to 9:00pm Cultural Program and Dinner Day 3 Sunday November 9, 2014 8:30am to 11:00am Plenary Session 11:00am to 5:00pm Conference Dr. R. Harihara Prakash Dr. Harvinder Singh Chabbra Highlights Laxmi Vilas Palace, Baroda (Distance from Conference Venue - 55 km) Participants Message from Chairperson Places nereby karamsad • Pre conference workshop on comprehensive management of SCI • Spinal Cord Socitey and ASCoN best paper and poster award • Topics of interest for whole team including doctors, therapists, nurses, Psycologists, social workers and peer counsellors • Prominent national and international faculty Payment details Option 1: (By Demand Draft) Demand draft drawn in favour of ‘Charutar Arogya Mandal’ payable at Karamsad. Option 2: (By Bank Transfer) Name of Account: Charutar Arogya Mandal Name of Bank: Bank of Baroda, Karamsad branch Account No.: 03050400000095 SWIFT Code: BARBINBBAN IFSC No.:BARB0KARAMS Branch Code: 0305