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- REGISTRATION FORM -
Savitribai Phule Pune University, Pune Sponsored
Two Days National Conference on 'Ethnomedicine: Prospects and Challenges in Global Healthcare Scenario’ & National Level Paper Presentation Competition 10th ‘INDIRA PHARMA ZEAL’ On 21st & 22nd February 2018 1. Full Name : __________________________________________________________ (Surname) (First) (Middle)
2. Class
: _____________________________________________________
3. Institution
: _____________________________________________________
4. Address : for Correspondence
_____________________________________________________ _____________________________________________________
Mobile
: ___________________ Email: __________________________________________
5. Abstract Submission for : Poster Presentation 6. Registration Fee:
Oral Presentation
Dates Registration* on or before 20th February 2018
Student
Faculty
Rs. 300
Rs.450
* Spot registration will also be available ( Demand draft drawn in the favor of, “Principal, Indira College of Pharmacy”, Payable at Pune.) . The DD should be submitted in person on 21st February 2018. The Scanned copy of the DD should be sent / Mailed along with the registration form. Note: 1.Photocopy of the registration form may be used. 2. The Scanned copy of the DD should be sent along with the registration form. 3. A single DD for multiple delegates from the same institution will be accepted
Please e-mail this dully filled form on or before 20th February 2018. Email: adminicp@indiraicp.edu.in Accommodation Required
Date: ___________
Yes
No
Signature of the Participant
REGISTRATION COMMITTEE 1. Mr. Amir Shaikh +919881785923, 2. Mr. Sunil Kakad +919970969085, 3. Mrs. Meghana Dabhadkar +918308020900