INDIAN BOARD OF ALTERNATIVE MEDICINES
        11th International Congress,
Convocation & Award Presentation Ceremony
10th & 11th January 2004, Hotel Hyatt Regency (5 Star), Calcutta

REGISTRATION FOR DELEGATES

Name:

Sex:

Male
Female

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Qualification/Titles:

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Currency:

U.S. Dollar
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Payment Details:-Bank Name:

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Dated:

Please tick if interested:

 I wish to read a paper on:

I wish to apply for an award. I wish to apply for M.D.(A.M.)
I wish to apply for Ph.D.(A.M.) I wish to apply for D.Sc.(A.M.)

I wish to attend the training workshop:

Pre-Congress(7,8 & 9th Jan 2004)
Post-Congress(12,13 & 14th Jan 2004)

In case of student, please type in your Roll No. and the course name, so that your certificate can be kept ready to be presented during the convocation.

The names of delegates who register themselves before 15th Dec 2003 will be published in the souvenir.

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