Registration form Registration Charges For rtgs payments Upto 30 Oct 2017



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Date20.04.2018
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TypeRegistration form




AOI

14th PhonoCon 2018

2nd to 4th Feb, AIMS and IMA House, Kochi


Registration form



Registration Charges For RTGS Payments






Upto 30 Oct 2017

After 30 Oct 2017

A/c Name: PhonoCon 2018

A/c no: 015500100240951

Savings account

Dhanlaxmi Bank, Edappally branch

IFSC: DLXB0000155

For Registration help: Contact

Dr. Unnikrishnan Menon

M.: +919447831755 | E-mail : phonocon2018@gmail.com



APSI Members

6500

7000

NonAPSI Members

7000

7500

PG Students

3500

4000

Speech Language Pathologist

3000

3500

Foreign Delegates USD $

$250

$300

Senior Citizens (older than 70 yrs.)

Free

Free

Accompanying Person

3000

3500

The above charges do not include the Workshops / Instructional courses.

Four Instructional Courses are planned (on the first two days).



The charges for these are as follows, to be paid in addition to the registration charge.

Injection laryngoplasty: 2000

Swallowing disorders: 2000

Stroboscopy: 2000

Care of Professional voice: 1500

The workshops are optional, with limited seats. Please choose and tick on a single selection.



Once confirmed, no refunds will be made.

Conference Website : www.phonocon2018.com

PhonoCon 2018 Registration Form


Name:


Address:


Pin Code: Mob Alternate No


Medical Council Reg. No:



E-mail ID:


Accompanying Persons Name: Mob
Accommodation Enquiry Required: Yes/No

Category

Consultant-APSI Member APSI Nonmember

Post graduate student Speech & Language Pathologist

Accompanying person

(Post graduates to bring certificate from head of the department of the institute.)

Participation in Paper presentation / Poster competition

Rising Star

Phonocon Award Paper (Laryngology)

Phonocon Award Paper (SLP)

Poster competition (Laryngology/SLP)

PG paper presentation




Conference Registration Rs.


Workshop Registration Rs.


TOTAL
Payment details Cheque/Demand Draft/Cash No..............................................................Dated.........................

Amount .................................................................................................. Bank ........................................................

For correspondence contact:

Dr.Unnikrishnan Menon



Mob: 919447831755 Email: phonocon2018@gmail.com


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