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• REGISTRATION FORM
 
8th International Course ‘Voicecon 2009’
Hands On Course on Evaluation and Management of
Voice Disorders & Compromised Laryngotracheal Airway
27th , 28th  & 29th  November 2009

To,
Dr. Sachin Gandhi
Course Director

Kindly enroll me for : please click on checkbox

 

• Whole Course ( 27th , 28th  & 29th  Nov )

 

• Whole Course without hands on training ( 27th , 28th  Nov )

 

• Only Hands on training ( 29th Nov )

 

• Name :

• Age :
• Sex :
• Qualification :
• Designation :
• Address :
• Phone (STD Code) : Fax :

• Mobile

Email :

• I enclose Demand Draft No.

for Rs. US $

on bank

Branch
in favour of ‘ Deenanath Mangeshkar Hospital & Research Centre’, Pune, India
 
Course fees :

Course

Delegates

P.G. Students /Fellows

 Whole Course
(21st,22nd,23rd Nov)

Rs.6000/-
US$ 300

Rs.4000/-
US$ 200

 Whole Course without hands on training
(21st & 22nd Nov)

Rs.2000/-
US$100

Rs.1200/-
US$ 60

 Only Hands on training
(23rd Nov)

Rs.4000/-
US$ 200

Rs.3000/-
US$ 150
- PG Students should enclose Certificate from the Department Head.
- Demand Draft should be drawn in favour of ‘Deenanath Mangeshkar Hospital & Research Centre’.
 
DEENANATH MANGESHKAR HOSPITAL & RESEARCH CENTER#0197BC