Amoebiasis Conference

Registration Form
*Personal Details (Block Letters or Printed)*
Salutation (Prof / Dr / Mr / Mrs / Ms)
Last Name	:
First Name	:
Name ( for used on name badge )	:
Gender
Company Name	:
Job Title	:
Address	:
Zip	:
Country	:
Tel. No	:
Fax No :	:
Mobile No :	:
Email :	:
Date of Arrival	:
Date Of Departure	:
Passport No	:
DOB	:
Valid Upto	:
Issued At	:
Accompanying Person Name	:
Passport No	:
DOB	:
Valid Upto	:
Issued At	:
Lecture Course	:
Symposium	:
Both Lecture Course & Symposium	:
Requirements : Please advise any special requirement regarding diet, health or physical disabilities
Note : For lecture course there is no registration charges for students.

(This form should reach by 4th january 2012) MAIL / FAX TO : INDEBO (INDIA) PVT. LTD. 116-113, AURAOBINDO PLACE, HAUZ KHAS, NEW DELHI 110016, INDIA TEL: 00 91 (0) 1147165500 FAX : 0091 (0) 1147165550 EMAIL : amoebiasis@indebo.com, mice@indebo.com, amebiasis2012@gmail.com WEBSITE : www.indebo.com

DELEGATE REGISTRATION FEES

FOR INTERNATIONAL DELEGATES

Student ( triple sharing basis)

US $ 300

US $ 350

FOR INDIAN DELEGATES

Regular in Twin Sharing	Rs.10500.00
Regular Single	Rs.14000.00
Student ( triple sharing basis)	Rs.8000.00

FOR CORPORATE / INDUSTRY
Rs. 25,000/person

Note : Same charges apply for each accompanying person

ABOVE REGISTRATION FEE ARE ON PER PERSON BASIS AND ARE INCLUSIVE OF:

Registration Fee
Accommodation for 03 nights at The Clarks Hotel, Khajuraho on full board basis
Arrival/Departure transfers from Khajuraho Airport/Railway Station & hotel Clarks & back
Excursion to Panna National Park with breakfast at Ken River Lodge
Guided Sightseeing tour of Khajuraho
Gala farewell dinner
Basic Wi-Fi services
All currently applicable taxes

Cost does not include :

RESTRICTED AREA PERMIT FEES, VISA CHARGES, AIRPORT TAXES ON DEPARTURE AND ITEMS OF PERSONAL NATURE SUCH AS, COST OF TELEPHONE CALLS, TELEGRAMS, TABLE DRINKS AND LAUNDRY ETC; ANY ITEM WHICH IS NOT SPECIFICALLY MENTIONED IN THE ABOVE INCLUSION LIST.