Medicinal Chemistry India 2013 MCI 2013 by cTLPdQ

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									                          Medicinal Chemistry India 2013 (MCI 2013)

                                       www. medchemindia2013.com

                                         Feb 11th – Feb 14 th 2013

                                        REGISTRATION FORM

NAME                           :                                                    SEX: M/F

QUALIFICATION                  :

EXPERIENCE                     :

INSTITUTION / INDUSTRY         :

PRESENT POSITION                   :

AREA OF SPECIALIZATION             :

YEARS IN DRUG RESEARCH             :

OFFICIAL ADDRESS               :



PHONE (OFFICE)                 :

MOBILE                         :

E.MAIL                         :

Registration fee Rs. 8,000/-   / Rs. 4,000/- in favor of ‘’Sri Ramachandra University, Med
Chem. 2013 A/C ’’ Payable at Chennai.

DD No                 :

DD Drawn On           :

Bank Name             :

Date                  :

Place                 :

Attestation Signature of the Industry/Institution                    Signature of Applicant
The filled in registration forms and demand draft in favor of “‘’Sri Ramachandra University,
Med Chem. 2013 A/C ’’ Payable at Chennai may be sent to The Organising Secretary,
Medicinal Chemistry India2013 (MCI 2013), Sri Ramachandra University, Porur,
Chennai, 600116. No application will be considered for admission unless accompanied with the
full payment. The Committee will review all applications and make its selections. Notification of
acceptance will be e. mailed

Please register on-line also for the course through www. medchemindia2013.com.

(Photocopy of this form may also be used)
                          Medicinal Chemistry India 2013 (MCI 2013)

                                      www. medchemindia2013.com

                                        Feb 11th – Feb 14 th 2013

                                      ACCOMADATION FORM

NAME                          :                                                    SEX: M/F

QUALIFICATION                 :

EXPERIENCE                    :

INSTITUTION / INDUSTRY        :

PRESENT POSITION                  :

AREA OF SPECIALIZATION            :

YEARS IN DRUG RESEARCH            :

OFFICIAL ADDRESS                  :



PHONE (OFFICE)                :

MOBILE                        :

E.MAIL                        :

Accommodation will be arranged on prior request in the university campus itself.

Rs. 750/- per day on sharing basis (2 persons) in favour of ‘’Sri Ramachandra University,
Med Chem. 2013 A/C ’’ Payable at Chennai.

DD No                 :

DD Drawn On           :

Bank Name             :

Date                  :

Place                 :                                 Signature of Applicant
The filled in accomadation forms and demand draft in favor of “‘’Sri Ramachandra University,
Med Chem. 2013 A/C ’’ Payable at Chennai may be sent to The Organising Secretary,
Medicinal Chemistry India2013 (MCI 2013), Sri Ramachandra University, Porur,
Chennai, 600116.

Please register on-line also for the course through www. medchemindia2013.com.

								
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