1. technology and computing
2. software
3. net conferencing

XVII NATIONAL SEMINAR ON HOSPITAL & HEALTHCARE MANAGEMENT
MEDICO LEGAL SYSTEMS & CLINICAL RESEARCH: 1st & 2nd May, 2015
and
CONNEXIONS Workshop & CONNEXIONS : 30th April 2015
Venue: Symbiosis International University, Lavale, Pune
REGISTRATION FORM
Date:
(To be filled in by the delegate & sent back to SCHC. You can photocopy this form for additional registration)
Name:
(In Block Letters)
Roll No. PGDHHM
Gender:
Male
____________________________________
PGDMLS
PGDCR
PGDHIM
Female
Address:
_
Tel. (STD)
______(O) _____________________(R)_______________________(Mobile)_____________________________
e mail :____________________________________________________________________________________________________________________
Sr. No.
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2
3
4
5
I am registering as
Student of Distance Education Programs offered by SCHC
Other Delegate
Alumnus
Medical / Law / Healthcare student
*Accompanying Person
Accompanying person no. 1 Name:
Accompanying person no. 2 Name:
Payment details: (Please refer to fees & tariff structure overleaf)
Sr. No
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2
3
4
5
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Particulars
(Please ‘√’)
Age:
Age:
Self
(amount in INR)
Gender:
Gender:
Accompanying
person
(amount in INR)
Total
Amount
INR
Connexion Workshop
Pre Conference Symposium
Delegate Registration for National Seminar
Networking Dinner
Accommodation
Transportation
Grand Total
Sr. No.
Option for Master Classes
( Please ‘√’ any one)
Convention Hall
1
Master Class I: Improving Patient Safety in Hospitals
Master Class III : Opportunities and Challenges in Health Insurance
Auditorium
2
Master Class II : Expanding Horizons in Diagnostic Care
Master Class IV: Special Laws related to Healthcare
Payment mode:
1) Enclose a Demand Draft No.__________________ Bank _____________ dated__________________for ₹. ___________________
(Kindly draw a D.D. in favour of “Symbiosis Centre of Health Care”, payable at Pune.)
2) Electronic payment by RTGS/NEFT: A/C Name Symbiosis Centre of Health Care, A/C no. 60052677905
Bank of Maharashtra, S.B. Road Branch, Pune, IFSC code- MAHB0001261
Please mention UTR/UTN number and attach acknowledgement receipt.
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Fees & Tariff Structure: (Per Head)
A. Early Bird Registration up to 14th January, 2015
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2
3
4
5
6
7
HHM/MLS/CR/HIM student delegate registering up to 14th January, 2015
 Alumnus ( Distance Education Department & Faculty of Health & Biomedical
Sciences, SIU)
 Students : Medical / Law / Healthcare Management
 Accompanying Person above 12 years
 Corporate/ Government / Any Other Delegates
Pre Conference Symposium for all category of delegates
Connexions Workshop
Transportation
Accommodation
a) Triple Sharing
b) Twin Sharing
Networking Dinner at Lavale
Complimentary
₹ 4000
₹ 1750
₹ 800
₹ 500
₹ 1200
₹ 1500
₹ 750
B. Registration from 15th January to 14th April, 2015
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2
3
4
5
6
9
HHM/MLS/CR/HIM student delegate registering up to 14th January, 2015
 Alumnus ( Distance Education Department & Faculty of Health & Biomedical
Sciences, SIU)
 Students : Medical / Law / Healthcare Management
 Accompanying Person above 12 years
 Corporate/ Government / Any Other Delegates
Pre Conference Symposium for all category of delegates
Connexions Workshop
Transportation
Accommodation
a) Triple Sharing
b) Twin Sharing
Networking Dinner at Lavale
₹ 4500
₹ 4500
₹ 1750
₹ 1000
Complimentary
₹ 1400
₹ 1800
₹ 750
C. Registration from 15th April, 2015 onwards & Spot registration
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2
3
4
5
6
7
HHM/MLS/CR/HIM student delegate registering up to 14th January, 2015
 Alumnus ( Distance Education Department & Faculty of Health & Biomedical
Sciences, SIU)
 Students : Medical / Law / Healthcare Management
 Accompanying Person above 12 years
 Corporate/ Government / Any Other Delegates
Pre Conference Symposium for all category of delegates
Connexions Workshop
Transportation
Accommodation
a) Triple Sharing
b) Twin Sharing
Networking Dinner at Lavale
₹ 5000
₹ 5000
₹ 2000
₹ 1500
Complimentary
₹ 1400
₹ 1800
₹ 750
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 Bus Schedule for transportation (S B road to Lavale, to & fro)
S. B. Road to Lavale
29th April, 2015
6.30 pm to 9.30 pm
30th April, 2015
6.30 am to 8.00 am
30th April, 2015
6.30 pm to 9.30 pm
01st May, 2015
6.30 am to 8.00 am
1st May, 2015
2nd May, 2015
3rd May, 2015
Lavale to S.B. Road
After networking dinner
Only after certificate distribution : 5.30 pm
at 09.00 am
 Accommodation Registration, Please ‘√‘ the room type of your choice
Room Type@
Symbiosis Lavale Campus
Check-in
Tick
Date
Time
Check-out
Date
Time
Triple Sharing (per head per
day)
Twin Sharing (per head per day)
e*
Note
1. *Accompanying person:
 Each Accompanying person has to register for National Seminar (Above 12 years of age)
and pay separately additional amount for accommodation, transport etc.
2. Spot registration subject to availability of seats.
3. Due to limited number, rooms will be strictly allotted on first come first serve basis. These are
available with reasonable charges and basic amenities. Complimentary Wi-Fi and Internet
facilities will be provided to delegates availing accommodation.
4. For academic sanctity, kids will not be allowed in the auditorium and convention centre.
5. Complimentary Recreation and Wellness facilities for delegates staying on campus during National
Seminar are –
 Gymnasium, Aerobics, Yoga, Badminton, Cardio Studio, Squash, Table Tennis, Pool Table,
Carrom, Swimming Pool.
To use the recreation and sports facilities you should carry compulsorily following items: Attire for Gym & Sport- Clean indoor shoes, shorts/track pants, T shirt, Towel & Water bottle.
 Attire for swimming Pool- swimming costume & swimming cap.
6. Transfer of registration under any category is not allowed.
7. Fees are non refundable.
8. Please refer website : www.schcpune.org for detailed program schedule (Tentative: Subject to
change)
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