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Page 1: FFE 2012 Registration Form

FFE Registration Form

Please Email us the details of people attending the conference

In case of Group bookings (multiple delegates) please �ll in separate forms giving individual details of delegates. A single cheque for total amount for the total number of delegates can be sent.

Delegate Fees for Service Provider Companies - Rs.7500/- Delegate Fees for Pharma Companies upto 3 delegates - Rs.6500/-

Prices are inclusive of Power Breakfast with Decision Makers, Networking Lunch and High Tea

For the invoice/bill generation – let us know the - Name of the Person, Company Name & Company Address

Cheques should be made in the name of “Knowledge Ventures” and couriered to :Mr.Arvind Nair, FFE 2012 Secretariat, B/205, Ahimsa Enclave, O� New Link Road, Chincholi, Malad West, Mumbai 400064.

First Name

Last Name

Gender

Company Name & Address

Pin

Telephone

Mobile

Email

Designation / Title

Payment Mode

www.medicinman.net

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For further details Contact: Mr.Arvind Nair, FFE 2012 Conference Director Contact : +919870201422 / [email protected]

Bank & Cheque No: Branch :

Amount : Dated :

Alternatively you can make an online payment to the account of Knowledge Ventures the details of the

same are as follows:

Account Name : Knowledge Ventures

Bank name : ICICI Bank

Current Account Number : 122105500002

IFSC CODE : ICIC0001221

Bank Address : ICICI Bank, Malad Link Road Branch, Shop No.6 & 7, Linkway Estate, Malad West, Mumbai 400064.

www.medicinman.net

FFE Registration Form

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