Download - Registration form
REGISTRATIONEarly bird Registration* Before Nov 30, 2011 Before Dec 30, 2011
Student INR 1000 INR 2000 INR 3000
Professional INR 2000 INR 3000 INR 5000
From Industry INR 3000 INR 5000 INR 7000
Workshop INR 1000 INR 1500 INR 3000
Enclosed Rupees ___________________________________________
__________________________________________________ (in words)
Rs.__________________________(in figures) through Demand Draft /
Cheque drawn in favour of “Pharmanext” payable at Delhi.
Name of the Bank___________________________________________
D.D./Cheque No. ___________________Dated __________
Place ___________ Date :_______ Signature ____________ Registration is non refundable and non transferable. ( No refund in case of cancellation. Only registered delegates will be allowed to attend the conference)
Please send the form along with the relevant details to:
ENQUIRIES & DETAILS
Please tick
S. No.
Pre Conference Workshop
Accomodation interested
Mr. aayush Agarwal : 8141800084Mr. Chintan Oza : 9427801975Mr. Harish Pal : 9818455437
Email: [email protected] [email protected]
L. J. Institute of Pharmacy Nr. Nagdev Mandir, Sanand-Sarkhej Circle, S G Road, Ahmedabad - 382210 (Gujarat)
Contact : 8141800084/9427801975/9818455437Email : [email protected],
www. pharmanextahmedabad.com, www.pharmanextworld.com
Cell
Phone Numbers with STD code
Pin Code
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“Innovation in Pharmaceutical Industry: From Drug Development to Distribution”
National ConferenceJanuary 28-29, 2012
Organized by
PharmanextTM L. J. INSTITUTE
OF PHARMACY AHMEDABAD
In Association with Supported by
Gujarat Technological University (GTU) B.V. Patel PERD Center
Bank TransferBank Name : ICICI BANK LIMITED
Branch : B 78, Defence Colony, New Delhi -110024, India Account Name : PHARMANEXT
Account Number : 630005008543Swift Code : ICICINBBCTSIFSC Code : ICIC0006300
REGISTRATION FORM
* Early bird registration is applicable before October 30, 2011.