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REGISTRATION NO.:
PERSONAL DETAILS



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  • By Draft/Cheque


Draft/Cheque No………………….....…....….......… Dated …………..........…..................…… Drawn on …………............……......…………… Favoring “10th WCOI & AAID Global Conference 2016” payable at New Delhi
  • Cash Payment


  • NEFT Transfer (Please append the cash deposit slip)

Account Name: 10th WCOI & AAID Global Conference 2016, Account No.: 90682010127100, Bank Name: Syndicate Bank, MAMC Complex, New Delhi - 110002, NEFT Code: SYNB0009068

  • For online registration please visit: http://www.wcoi2016.com/Registration.aspx

Cancellation Policy:


  • Refund will be provided with written notification and original registration receipt.

  • Before 15th Sept. 2016 Full refund will be done. Post 15th Sept. 2016 no refund shall be made.

Send your duly filled form to Conference Secretariat at:





DELEGATE

REGISTRATION FORM

th

World Congress for Oral Implantology & AAID Global Conference 2016

(Co-organised with 5th ICOI South-East Asia Conference)

11th - 13th November, 2016

Venue: The Leela Ambience Convention Hotel, New Delhi - 110032 (India)

Prof. (Dr.) Mahesh Verma

President, 10th WCOI

Maulana Azad Institute of Dental Sciences, MAMC Complex, Bahadur Shah Zafar Marg, New Delhi - 110002 (India)

Tel.: +91-11-2323-3925, Fax: +91-11-2321-7081

E-mail: dpmaids@gmail.com, wcoidelhi@gmail.com

Dr. Brij Sabherwal

Organising Secretary, 10th WCOI E-7, Lajpat Nagar - III,



New Delhi - 110024 (India)

Tel.: +91-98111-62113, 93500-04448

E-mail: drbrijsab@gmail.com

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