Fellowship Course ofIndian Association of Gastrointestinal Endo Surgeons

23 - 25 June 2016

FIAGES KOLKATA 2016

Venue : Medical College, Kolkata

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IAGES EXECUTIVE COMMITTEE

FOUNDER PRESIDENT & TRUSTEE

Dr. Tehemton E. Udwadia

PRESIDENT

Dr. Ramesh Agarwalla

PRESIDENT ELECT

Dr. A Zamer Pasha

IMM. PAST PRESIDENT

Dr. Abhay N Dalvi

HON. SECRETARY

Dr. Sayandev Dasgupta

HON. TREASURER

Dr. Ramen Goel

ADVISORY COMMITTEECHIEF TRUSTEE

Dr. Kuldip Singh Dr. Pradeep Chowbey

Dr. K. Ravindranath

Dr. B. Krishna Rau

Dr. H. G. Doctor

Dr. M. G. BhatTRUSTEES

Dr. Ajay Kriplani

Dr. Suresh Deshpande

Dr. John Thanakumar

Dr. V Venkatesh

VICE PRESIDENTS

West Zone :

Central Zone :

South Zone :

North Zone :

East Zone :

Dr. Sunil D. Popat

Dr. Amitabh Goel

Dr. Ashwin Masurkar

Dr. Sumeet Shah

Dr. Satyapriya De Sarkar

EXECUTIVE COMMITTEE MEMBERS

West Zone East Zone

Central Zone North Zone

Dr. Aparna Despande

Dr. Roy Patankar

Dr. Pramod Shinde

Dr. Jaya Maheswari

Dr. C R Das

Dr. Sreejoy Patnaik

Dr. Vijay Mittal

Dr. Sarfaraz Baig

Dr. Rakesh Shivhare

Dr. Achal Gupta

Dr. Sumit Shukla

Dr. Siddharth V Tamaskar

Dr. Vandana Soni

Dr. Manish Baijal

Dr. Subhash Aggarwal

Dr. Meenakshi Sharma

South Zone

Dr. K Govindraj

Dr. L P Thangavelu

Dr. T Siva Kumar

Dr. Easwaramoorthy

CO-OPTED MEMBERS

Dr. Rajesh Khullar, Dr. Kona Kumari Laxmi, Dr. Suresh Vasistha, Dr. Navneetha Krishnan

Dr. Deepraj Bhandarkar, Dr. Satish Midha

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Dear Friends & Colleagues,

It is a pleasure and privilege to invite you to “FIAGES KOLKATA – 2016”, which is going

to be held from June 23 -25 2016 at Medical College and Hospital, Kolkata.

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The Indian Association of Gastro-Intestinal Endo Surgeons (IAGES) is a vibrant and

dynamic organization of more than 5000 members with the vision of promoting and

spreading the art and science of laparoscopic and endoscopic surgery throughout

India and abroad. FIAGES is the certified fellowship of the IAGES. The Fellowship of

the IAGES is unique since it takes into consideration the seniority and contributions of

the senior surgeons and at the same time assesses the competence of the young

surgeons by an examination after a structured course. The aim of the fellowship is to

establish uniformity and highest standards of practice and training in endosurgery.

“FIAGES KOLKATA – 2016” will be a three day course comprising of Didactic Lectures,

Live Laparoscopic Surgery Workshop, Hands on Laparoscopic Training on

Endotrainers and Unique Meet the Professor sessions. The teaching and training will

be followed by written and assessment of the candidates. On successful

completion of the course, the candidates will be eligible to receive the much coveted

FIAGES certificate at the convocation ceremony in next IAGES Annual Congress.

Please note that IAGES Membership is mandatory prior to taking up the FIAGES

certification course.

The venue for the course is Medical College, Kolkata in the heart of Kolkata. It has all

the facilities with ample parking space.

We look forward to welcome you at FIAGES KOLKATA-2 016.

ORGANISING COMMITTEE

DR. T. E. UDWADIA

(FOUNDER PRESIDENT)

DR. RAMESH AGARWALLA

(PRESIDENT)

PROF. K. N. DAS

(ORGANISING CHAIRMAN)

DR. SAYANDEV DASGUPTA

(HON. SECRETARY)

PROF. GARGI BANDYOPADHYAY

ORGANISING SECRETARY

DR. SATYAPRITYA DE SARKAR

VICE PRESIDENT (EAST ZONE)

DR. SAURAV GHOSH

TREASURER

DR. SUBHASH KHANNA

(FIAGES CONVENOR)

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Course DetailsIAGES Fellowship Course

Course Structure

Non Examination Category

Examination Category

Written examination

Practical Examination

The skill assessment on Endo trainer

Interview / Viva

I AGES will conduct a 3 days fellowship course, at Kolkata from 23 to 25 June 2016.

The course will be a balanced mix of didactic lectures by eminent faculties with ample time for

discussions, video presentation, open house sessions, symposia and direct informal interaction of

groups with eminent faculty [Meet the Professors], Participants will get ample time on Endo trainer

under close guidance and supervision of faculties to improve their hand eye coordination by

structured exercise. Besides the allotted time, there will be liberal availability of Endo trainers at

other times. The objectives of the course are to impart and update with many unique features in this

course to make it more useful, convenient and memorable for you.

For non Examination Category, minimum of 10 years of experience of Laparoscopic Surgery is

required after the post graduation. You are expected to have performed over 250 laparoscopic

procedures. Submission of some evidence or under taking is required to substantiate your

claim of having vast experience in the field of minimal access surgery. The candidates registered

in this category are required to attend all the lectures on 1st and 2nd day and live workshop on

3rd day. A formal interview of these candidates will be taken by FIAGES board members.

For examination category, the candidates are required to have minimum of 2 years of

experience in, Laparoscopic surgery after post graduation in surgery. They are expected to

have performed over 25 laparoscopic procedures independently or jointly. They have to attend

proceedings on all 3 days including the endo trainer session and meet the professor session. On

the 3 day they will appear for the examination. The endo trainer sessions are very important

part of the fellowship course. During the session they will be trained in performance of

specified tasks and specific exercise including Endo knotting and suturing. On the last day the

evaluation will be on the CME exercise.

There will be short essay type question &/or MCQs. Theory Exam will be 100 Marks &

Candidates are required to obtain minimum of 50 % marks to pass. The answer should be brief

and to the point. The answer sheets are checked by five faculty members. Each answer sheet is

checked by one examiner only.

[It has two parts]

(1) is based on performing simple to advanced

exercise, approximately 10 minutes for each candidate. Maximum of 50 marks are

allotted on Endo trainer assessment. Five faculty members are deputed as examiner. Each

candidate is examined by one examiner only.

(2) approximately 10 minutes for each candidate. The candidates are

divided into batches and are interviewed by two or more senior most faculty members of

IAGES depending upon the number of candidates. Maximum of 50 marks are allotted for

the interview.

Total marks for practical examinations are 100 [Endotrainer assessment 50 marks & interview

50 marks]. A minimum of 50 marks are required to pass separately in practical examination

combing the endotrainer assessment and interview. No Marks for the attendance. Attendance

is Compulsory.

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IAGES membership is compulsory for Fellowship course.

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Criteria of FIAGES Course

IAGES membership is mandatory.

Candidates need to have 2 years of experience post MS/DNB by May 2016.

Non members will submit duly filled IAGES membership form with passport size photo. A

separate DD of 4,000 in the Name of IAGES before or along with Registration.

Attach the MBBS, MD or DNB, Medical Council Registration Certificate (Kindly enclose Xerox

copy)

Cases of laparoscopic appendectomy, laparoscopic cholecystectomy, laparoscopic repair of groin

hernia both TEP and TAPP, laparoscopic repair of ventral/incisional hernia and other cases

subject to availability.

Trainees will get ample opportunity to practice knotting and suturing in the lap trainer under the

direct supervision of Faculty on day 1 and day 2. Final practical assessment of suturing skill will be

on day 3.

It is a good opportunity for young surgeons to discuss freely on common issues in both basic and

advanced laparoscopic surgery. Delegates can choose the appropriate session to attend to clarify

their doubts in the particular area like Lap chole session, Lap Hernia session, Lap Solid organ

session, Session on setting up laparoscopic unit and sterilization issues etc.

Attendance is compulsory for all FIAGES course participants on all days.

Participants are requested to a day which is mandatory and stay in the

hall till the proceedings are over and at the end.

The participants are requested to reach Kolkata on the evening of 22nd June or in the

morning of 23rd June before 8.00 A.M.

Comprehensive Laparoscopic Surgery (can be downloaded from the IAGES website)

Textbook of Laparoscopy Surgery: Dr. T. E. Udwadia

The SAGES Manual

Laparoscopic Surgey: Dr. Alfred Cuschieri

Laparoscopic Surgery: Zucker & Baily

A fellowship certificate will be given only in person to the successful candidate in convocation

ceremony during the national conference of IAGES. A certificate of attendance will be given at the

end of this course.

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Live Operative Workshop

Lap Trainer Session

Meet the Professor Session

Instruction to Course Participants

sign in four times

sign out

Recommended reading for the FIAGES course.

Award of Fellowship Certification

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Registration Fee

ELIGIBILITY 2 YEARS POST MS/DNB

COURSE FEES Rs 12000/-

MEMBERSHIP FEES Rs 4000/-

sFOR ALL OTHER ATTENDING DOCTORS REGISTRATION FEES R . 2500/-

Note

"FIAGES KOLKATA 2016" KOLKATA

Name of A/c : FIAGES KOLKATA - 2016

A/c No. : 0835050013527

Bank: UBI Bank

Branch: MCH Branch

IFS Code: UTBIOMCHA13

For IAGES Membership : DD of an amount of 4000/- drawn in favour of

IAGES - Mumbai, payable at Mumbai.

IAGES 2017 at Hyderabad

: Non IAGES members cannot appear for fellowship exam. They can attend the

CME and workshop.

Demand draft / at par cheque should be made in favour of

Payable at or Can be sent by NEFT:

Spot registration for the fellowship course and the live workshop may kindly be

avoided.

Non IAGES member can send the form of IAGES membership with duly filled

Registration form to become eligible for the fellowship and avail registration fee as

IAGES members.

For Membership of IAGES please log on www.iages.in

Kindly make separate DD for membership of IAGES and for FIAGES course.

All Successful fellowship candidates have to register for the National Conference,

for award of the fellowship certificate.

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For Registration you may kindly contact : Mrs. Rakhi Saha - 9836765353

Please fill in the form (FIAGES & IAGES Membership) and attache the rquired

document and DD and kindly send it back to the following address

Prof. Gargi Bandyopadhyay, Organizing Secretary

50/1B, Harish Mukherjee Road, Kolkata - 700 025, West Bengal, India

Conference Secretariat:

Prof. Gargi Bandyopadhyay

Organising Secretary

Department of Surgery, Medical College, Kolkata

88, College Street, Kolkata - 700 073

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DAY 1, FRIDAY , 2016

DAY 2, SATURDAY , 2016

NO FANCY SURGERY DEMO - ABSOLUTELY BASICS

23 JUNE

24 JUNE

DAY 3 25 JUNE 2016 OPERATIVE WORKSHOP

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08.00AM - 09.00AM REGISTRATION

08.55AM - 09.00AM Introduction

09.00AM - 09.20AM History of Laparoscopy

09.20AM - 09.40AM Endo-Vision System

09.40AM - 10.00AM Hand Instruments, Accessories & Ergonomics

10.00AM -10.20AM Sterilisation of Instruments & Maintainance

10.20AM - 10.40AM Energy Sources in Laparoscopy

10.40AM - 11.00AM COFFEE BREAK

11.00AM -11.20AM Training in Laparoscopy & Starting A Laparoscopy Unit

11.20AM - 11.40AM Peritonial Access, Access Complications & Prevention

11.40AM - 12.00PM Physiology of Pneumoperitoneum & Anaesthesia in Laparoscopy

12.00PM - 12.20PM Tissue Approximation & Endosuturing

12.20PM - 12.40PM Standard Lapchole

12.40PM - 01.00PM Difficult Cholecystectomy, Tips & Tricks

01.00PM - 01.30PM LUNCH

01.30PM - 01.5OPM Management of Lap Biliary Injuries

01.50PM - 02.10PM Management of CBD Stones in Era of Laparoscopy

02.15PM - 02.45PM Panel Discussion on Complications of Lapchole

02.45PM - 03.05PM Lap Appendicectomy

03.05PM - 03.25PM Emergency Laparoscopy (Other than Appendix)

03.25PM - 03.45PM Inguinal Anatomy

03.45PM - 04.05PM TAPP

04.05PM - 04.25PM TEP

04.30PM - 05.30PM MEET THE PROF & ENDOTRAINER SESSION : 1. GB : 2. Hernia : 3. Basics & Appendix

05.30PM - 06.30PM INAUGURATION

08.00AM - 09.00AM MEET THE PROFESSOR

09.00AM - 09.20AM Prosthetic Materials and Fixation Devices in Hernia Surgery

09.20AM - 09.40AM Lap Ventral Hernia (IPOM)

09.40AM - 10.10AM Panel Discussion on Complications of Lap Hernia Surgery

10.10AM - 10.30AM Laparoscopic Surgery for Esophagus & Stomach (Benign)

10.30AM - 10.50AM Laparoscopic Surgery for Esophagus & Stomach (Malignant)

10.50AM - 11.10AM Laparoscopic Surgery for Spleen & Adrenals

11.10AM - 11.40AM COFFEE BREAK

11.40AM - 12.00PM Lap Surgery of Liver & Pancreas

12.00PM - 12.20PM Lap Surgery for Benign & Malignant Diseases of Large Intestine

12.20PM - 12.40PM Lap Gynecological Surgery for General Surgeons

12.40PM - 01.00PM Lap Urological Surgery

01.00PM - 01.20PM Laparoscopic Obesity & Metabolic Surgery

01.20PM - 02.00PM LUNCH

02.00PM - 02.2OPM Medico-Legal Aspects

02.20PM - 02.40PM VATS/ Thoracoscopic Surgery

02.40PM - 03.00PM Laparoscopic Paediatric Surgery

03.00PM - 03.20PM Robotic Surgery - Today & Tomorrow

03.20PM - 03.40PM Video Recording, Editing & Paper Presentation

04.00PM - 06.00PM Theory Exams - Exam Category Interview - Non Exam Category

08.30AM - 01.00PM Standard Lapchole, Exam Category Interview at the same time

Standard Lap Appendix, TAPP, TEP, Small defect Ventral Hernia - Optional

Theory Paper Setter - Dr. Subhash Khanna

Theory Paper Examiners : Dr Subhash Khanna + To be decided

Endotrainer Examiners To be decided

Oral Examiners : Dr. Subhash Khanna + To be decided

Scientific Programme

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Working Committee

PROF. GARGI BANDYOPADHYAY

ORGANISING SECRETARY

Prof. Bitan ChattopadhyayProf. Manju BanerjeeProf. M L SahaProf. D K SarkarProf. Anil SahaProf. N. N. MukhopadhyayProf. Gautam DasProf. Nemai C NathProf. Q M RahamanProf. Hiranmoy BhattacharyaProf. D RoyProf. S S Bhoj

Prof. Tamonas ChaudhuriProf. Saibal MukherjeeProf. Ajoy RoyProf. Anil SahaProf. Sukumat MaitiProf. Shibajyoti GhoshProf. S. R. GhoshalProf. Sudev SahaProf. Amitava SarkarDr. Sanjay De BakshiProf. U. BhattacharyaProf. U. De

Prof. Anand SagarProf. Anadi AcharyaProf. T. KhamruiProf. D. KunduProf. M. K. DasProf. Sandip MazumdarProf. Saugata SamantaProf. Sankar Das ChatterjeeProf. Nishit KarmakarProf. Prasanta BhattacharyaProf. Abhimanyu BasuProf. Subhabrata Das

ADVISORY BOARD

LOCAL ORGANISING COMMITTEE

DR. SAURAV GHOSH

TREASURER

PROF. K. N. DAS

ORGANISING CHAIRMAN

Dr. Udipta RayDr. Amarendra Nath SarkarDr. Sudarshan SenDr. T K BiswasDr. Niladri SarkarDr. Dhrubajyoti BhowmickDr. Madhumita MukhopadhyayDr. Krishnendu MukherjeeDr. M. C. JhunjhunwalaDr. S. K. JhunjhunwalaDr. Rabin DebnathDr. V. LakshmanDr. Somdutta LahiriDr. Sandip HalderDr. Ramanuj MukherjeeDr. Nishit Kr. MallikDr. Aswini MalhotraDr. G. S. PiparaDr. S. S. Roy Chowdhury

Dr. C. Roy ChowdhuryDr. Dhritiman MaitraDr. Pankaj SarakarDr. Bidyut BiswasDr. Mriganka GhoshDr. Abhiram MajhiDr. Ajoy Kr. PaulDr. M. N. HaqueDr. L. S. ChenDr. S. N. BasakDr. G. C. DasDr. Mukesh KariaDr. Aniruddha DasguptaDr. Ajoy MondalDr. S. P. BankaDr. Sankar BhattacharyaDr. Sanjay DubeyDr. Yogesh BavisiDr. P. P. Singh

Dr. Saugata DeDr. Md. Raja HaiderDr. Sanjay GuptaDr. S. ChakrabortyDr. T. K. JanaDr. P. K. MishraDr. G. BhowmickDr. Kalyan Kr. SarkarDr. Plaban BiswasDr. H. P. MondalDr. Yatrik BiswasDr. Dwaipayan SamaddarDr. Ajoy Kr. SenDr. Rajat BhattacharyaDr. A. BhartiaDr. Sandip RayDr. Ambar GangulyDr. Nasir Iqbal

DR. SARFARAZ BAIGEXECUTIVE COMMITTEE MEMBER (EAST ZONE)

DR. P. K. NEMANICHAIRMAN, SCIENTIFIC COMMITTEE

DR. ARGHO RAY

WORKSHOP CO-ORDINATOR

CHIEF PATRONS

Prof. Tapan Kr. LahiriProf. Susanta Kr. Bandyopadhyay Prof. Bhabatosh BiswasProf. Niranjan Bhattacharya

PATRONSProf. Urmila Khanna, Prof. Asit Kumar Banerjee, Prof. Dilip Kumar Chakraborty, Prof. Tamal Kanti Choudhury

Dr. Alok Banerjee, Dr. Kalyani Banerjee, Dr. V. K. Bhartia, Dr. S. K. Agarwal, Dr. Om Tantia

Prof. Himadri SenguptaProf. Pallab GhoshProf. Kishore ChowdhuryProf. Gautam Chatterjee

Dr. Tapanjyoti BanerjeeProf. Debasish Bhattacharya

Dr. Arnab GuptaDr. P. B. KarProf. Dibyendu GautamProf. P. G. SarkarProf. P. S. PaulProf. S. Poira

Dr. Purnendu RoyDr. Dipankar SenguptaDr. Sankar MitraDr. R. P. LadhaniaDr. Manas RoyDr. Ashok SarafDr. Pratip SenguptaDr. Prantik ChowdhuryDr. Nilanjan PandaDr. Sanjay SilDr. Kalyan KarDr. Sanjay MandalDr. Santanu KarDr. D. K. ChattopadhyayDr. B. RamanaDr. Sumit GulatiDr. G. S. Bhattacharya

Dr. Rajesh BarasiyaDr. Soumen DasDr. Saumitra ChandraDr. Deb Kumar RoyDr. Abir BanerjeeDr. Dipankar SarkarDr. Subhasis SahaDr. Debasis RoyDr. Naba Kumar SahaDr. Sumit ChaudhuryDr. Swaraj BhattacharyaDr. Moinul HasanDr. Pinaki BanerjeeDr. Ratnajit DasDr. Bikash Ghosh

Fellowship Course of Indian Association of Gastrointestinal Endo Surgeons

FIAGES KOLKATA 2016

Venue : Medical College, Kolkata

Name ...............................................................................................................

Age / Sex ...................

Address ............................................................................................................

............................................................................................................

Phone : [Hosp.).............................[Resi.] ......................... Mob............................

IAGES Membership No.:............................PG Student Non Member

Medical Council Reg. No.: ....................................................................................

Accompanying Person :........................................................................................

Total Amount:.....................................................................................................

Mode of Payment: Cash / at par Cheque / Demand Draft on FIAGES KOLKATA - 2016

No.........................................Dated........................ Payable at Kolkata

or can be sent by NEFT:

Name of Bank: UBI Bank

A/c No.: 0835050013527

IFS Code: UTBIOMCHA13

Branch: MCH Branch

Name of A/c.: FIAGES KOLKATA - 2016

Date: Signature

Organising Secretary

Department of Surgery, Medical College, Kolkata

88, College Street, Kolkata - 700 073

M/F Qualification : MS Mch DNB

City: ................................................ Pin : .............................................

ELIGIBILITY 2 YEARS POST MS/DNB

COURSE FEES Rs. 12000/-

MEMBERSHIP FEES Rs. 4000/-

s

REGISTRATION FEE

Prof. Gargi Bandyopadhyay

FOR ALL OTHER ATTENDING DOCTORS REGISTRATION FEES R . 2500/-

Note : Non IAGES members cannot appear for fellowship exam. They can attend the

CME and workshop.

23 - 25 June 2016

[Please see overleaf for the instructions]

Step 1:

Step 2:

To become IAGES Member:

Note :IAGES Membership : DD to be made in favour of IAGES - Mumbai, payable atMumbai.

Step 3:

Step 4:

Step 5:

Fill this Registration form. Direct Money Transfer;

A/c. No. :

IFSC :

Fill the IAGES membership form and attach DD of 4000 in the name of "IAGES -Mumbai payable at Mumbai. Attach all the necessary photocopied documents -namely, postgraduate degree certificates and Medical council registration. No NonIAGES members would become eligible for FIAGES fellowship examination and alsoavail registration fee as IAGES members.

Send both the forms and their DDs to the conference Secretariat and receive thereceipt either by post or in Person

Make your own Travel and Accommodation arrangements. Call Event Managers forany help. Exam category candidates may have to stay late on evening of last day for vivaand hence advised to plan return travel accordingly.

After the successful completion of course, register to attend the IAGES AnnualConference at Hyderabad to receive the fellowship certificate at the convocationceremony.

NAME OF A/C. : FIAGES KOLKATA - 2016

0835050013527

UTBIOMCHA13

UBI Bank

MCH Branch

BANK :

BRANCH :

`

Steps of Registration Process

Please fill in the form and send it back to the following address

Prof. Gargi Bandyopadhyay, Organizing Secretary

50/1B, Harish Mukherjee Road, Kolkata - 700 025

West Bengal, India

INDIAN ASSOCIATION OF GASTROINTESTINAL ENDOSURGEONS

To

The Hony Secretary IAGES

Dear Sir,

I wish to apply for active / student / associate / international / corporate membership of the IAGES.

Name

(Surname) (first name) (middle name)

Date of birth ................................................. Sex M/F ............... Citizenship passport No ..............................................

Permanent Address .........................................................................................................................................................

City ...................................................................... State....................................................... Pin ......................................

E-mail .......................................................................................... Website ......................................................................

Telephone/ Fax City Code ..........................................

Office Residence

1) ..................................................... 1) .......................................................................

2) ..................................................... 2) ........................................................................

Cellular ............................................. Fax No. Off..................................................... Res ........................................

Medical Registration No ......................................................................................... Country State .................................

Academic Qualification Year University / Institution

Institution Duration From (Date) Teacher

..................................... ................................ ........................... ................................

..................................... ................................ ........................... ................................

Designation Institution From To

Personal Particulars (in block Letters)

Training In Endoscopic Surgery / Procedures

Appointments / Experience

..................................... ................................ ........................... ................................

..................................... ................................ ........................... ................................

..................................... ................................ ........................... ................................

..................................... ................................ ........................... ................................

..................................... ................................ ........................... ................................

..................................... ................................ ........................... ................................

..................................... ................................ ........................... ................................

..................................... ................................ ........................... ................................

..................................... ................................ ........................... ................................

APPLICATION FOR MEMBERSHIP

Serial No............................ Dated............................. Passport Size

Photo

Membership Of Other Associations/Societies

Sponsors

Instruction for application. Please enclose the following:

For Office Use

Association/Society Membership No.

..................................................................................... .............................................................................

I, hereby certify that the above information is correct to the best of my knowledge and I agree to Abide by rules and bye-

laws of the India Association of Gastrointestinal Endo-Surgeons.

Date .............................................................. Signature .............................................................

Address Of the Institution/Hospital Attachment

........................................................................................................ Tel. No .........................................................

........................................................................................................ Fax ..............................................................

1. Name 2. Name

Membership No. of IAGES Membership No. of.lAGES

Address: Address:

Signature Signature

• Attested photocopies of all certificates of academic qualification & registration of medical council.

• Two copies of passport size photograph in colour

•

• Return the completed application from to:

• Dr. Sayandev DasGupta

Hon Secretary IAGES

107 Ballygunge Gardens

Kolkata - 700029

Mob 9830030390

Email: sayandev.dasgupta@gmail.com

Application No ....................................................Received on ....................................... Submitted .................................

Approved/rejected on ........................................ Membership subscription of Rs./$ ........................................................

Received on ........................................................Vide cheque / demand draft No ............................................................

Dated .................................................................Drawn on ..............................................................................................

Membership No ...............................................................................................................................................................

..................................................................................... .............................................................................

Demand draft for Rs. 4000/- drawn in favour of "lAGES-Mumbai, payable at Mumbai. Personal cheques,

bankers cheques, etc are not acceptable.