Click Here to download the registration form in microsoft word format.

6th International Course

‘Voicecon’ 2007

Hands On Course on Evaluation and Management of

Voice Disorders & Compromised Laryngotracheal Airway

22,23,24 25 November 2007

Registration Form

To, Dr. Sachin Gandhi, Course Director

Kindly enroll me for:

Coures for speech Language pathologists(22th Nov)

Whole Course(23th,24th,25th Nov)

Whole Course without hands on training(23th,24th Nov)

Name: _____________________________________Age: __________Sex: ________

Qualification: _____________________________ Designation: _________________________

Address _____________________________________________________________________

Phone: ______________ Fax: _______________ Email: _______________________________________

I enclose Cheque/Demand Draft No.________________ for Rs.___________ US $ _________

on bank ______________________________________Branch ________________________

in favour of ‘Deenanath Mangeshkar Hospital”, Pune, India.

Signature ____________________

 

Course fee	Delegates	P.G. Students /Fellows (enclose certificate from HOD)
Coures for speech Language pathologists(22th Nov)	Rs.750/US$25	Rs.500/US$ 15
Whole Course(23th,24th,25th Nov)	Rs.5000/US$250	Rs.2500/US$ 125
Whole Course without hands on training(23th,24th Nov)	Rs.3000/US$150	Rs.2000/US$ 100

 

Places for Cadaveric Dissection are limited, early registration is advised.

Powered by www.t-softindia.com Home Top