S S U MIT 18 O B Bossummit with a difference ITC Gardenia, Bangalore · Hospital / Institution:...
Transcript of S S U MIT 18 O B Bossummit with a difference ITC Gardenia, Bangalore · Hospital / Institution:...
BOS S
UMMIT 2018Bossummit with a difference
Under the aegis of KOS
Name*: ______________________________________________________________________________________________________
Age: ___________ Sex: M F
Hospital / Institution: ________________________________________________________________________________________
Mailing Address: ____________________________________________________________________________________________
____________________________________________________________________________________________
Mobile No*: ___________________________________ Email*: _______________________________________________________
BOS Member KOS Member Membership No._________________ Others Fellow / Post Graduate
KMC / Other Medical Council No*: _______________________________________ Food Preference: Veg Non-Veg
*Mandatory fields to be filled
Please find enclosed Rs.__________________________, in words ________________________________________________
By Cheque/DD No.______________________ dated ______________ drawn on ___________________________________
Signature of Participant
REgiStRAtiON FEES
Early Bird up to April 30th, 2018
Late Fee up to June 5th, 2018
Spot Registration
BOS / KOS Members / Others
` 3,000 ` 3,750 ` 4,250
PG / Fellows ` 2,000 ` 2,500 ` 3,000
• PG/Fellows:LetterfromHOD/InstituteandacopyofIDCardisnecessary• RegistrationFeeincludesDelegateKit,AdmissiontoScientific/TradeExhibitions,Lunch
andCoffee• SpotRegistrationDelegatesareNOTELIGIBLEforCMECreditHours(NewKMCrules)• CMECreditHourssubjecttoattendanceofentireprogrammefor2days• Certificateswillbeissuedat5.00pmonlytodelegateswhoregisterbeforeJune5th,2018• Norefundswillbemadeforcancellations• Useoneformforeachregistration
23rd and 24th June, 2018, ITC Gardenia, Bangalore
For queries contact: 9342935370 / [email protected] / [email protected]
MOdE OF PAyMENt•DD/Chequeinfavourof
“Bangalore Ophthalmic Society”•Throughwebsite:
http://www.bangaloreophthalmicsociety.org(kindlysendusanemailtobossummit18@gmail.comwithtransactiondetailsandbankname,sothatthe
transactioncanbetracked.Please mail the completed Registration Form
along with DD / Cheque to:dr Sheetal Ballal, OrganisingSecretary,
BangaloreWestLionsSuperspecialityEyeHospital,No5,LionsEyeHospitalRoad,OffJCRoad,
Bangalore560002