ffe 2012 registration form

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FFE Registration Form Please Email us the details of people attending the conference In case of Group bookings (multiple delegates) please fill 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, Off 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 F M Page 1

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Pharma Strategic Time Out - Take a Break and Attend FFE 2012 & Gain Insights that will Sharpen Your Ax. If Field Force is Your Largest Expense, Learn How to Get the Best ROI from Pharma Leaders of Abbott, Sanofi, GSK, Glenmark, Novartis, Panacea, Ranbaxy, Merck etc;

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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

F M

Page 1

Page 2: FFE 2012 Registration Form

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

Page 2