TRAINING REGISTRATION FORM
Title
:
Mr.
Ms.
Mrs.
Dr.
Prof.
Surname
:
First Name
:
Professional Address
:
Phone
:
Mobile
:
Fax
:
E-mail
:
Dates
to participate in Laparoscopic Learning Course on
Apr. 2-3, 2005 (Saturday, Sunday)
July 2-3, 2005 (Saturday, Sunday)
Sept. 24-25, 2005 (Saturday, Sunday)
Nov. 25-26, 2005 (Friday, Saturday)
Fees
Rs. 10,000/- ($ 250) for Practicing Surgeons
Rs. 5000/- ($ 125) for Postgraduates
Payment Options
- Cheque,
- Draft
in favour of
Global Healthcare Foundation
to be sent to
Medical Director
Global Hospital and Endosurgery Institute,
Ambika Vihar,
NewDelhi - 110087
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