In partnership with
BioAsia: The Global BioBusiness Forum February 22 – 24, 2018, HICC, Hyderabad
Special Registration Form for Govt. of India’s R&D Institutes Participant(s) Details: Name:_________________ Designation:_______________ Email: _______________ Name:_________________ Designation:_______________ Email: _______________ Name:_________________ Designation:_______________ Email: _______________ Name:_________________ Designation:_______________ Email: _______________ Name:_________________ Designation:_______________ Email: _______________ Name:_________________ Designation:_______________ Email: _______________ Name:_________________ Designation:_______________ Email: _______________ Name:_________________ Designation:_______________ Email: _______________ Name:_________________ Designation:_______________ Email: _______________ Name:_________________ Designation:_______________ Email: _______________ Organisation: _______________________________Tel: _______________________ Address: _____________________________________________________________ _____________________________________________________________________ (Note - Email is required to enable the business partnering access to the registered delegates)
Payment Details: Actual Registration Fee for 10 participants – INR 1,40,000
Special Registration Fee for 10 participants – INR 30,000 Cheque / DD No. ______________Date: __________ Bank Name & Branch: ________________ Amount (INR): __________________________________________________________________ (Note: Cheque / DD has to be drawn in favor of “FABA-BIOASIA” payable at Hyderabad) Filled in forms may please be sent to Ms. Paridhi Gupta, Global Head of Business Development & Partnerships Email: paridhi@bioasia.in | Phone: +91 9177749651