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Registration Form

STEP 1. Registration Information

Mr. Ms.  Mrs.   Dr. Prof.

First Name : 

Last Name : 

Title : 

Dept : 

Institution : 
Address : 
Address : 
City : 
State : 
Zip : 
Country : 
Email :   
(Phone And E-mails required to process form )
Telephone : 

Fax : 

Dead Lines Foreign Indian Student

Advance Registration Discount until November 30, 2005

 $200* Rs. 1000# Rs. 700#
After November 30, 2005 $250* Rs. 1000# Rs. 700#
Accompanying Person $100+ Rs. 500+ Rs. 500+
If accommodation required please mention cost preferences       Rs.                           To Rs.
* Includes 3 nights shared accommodation with breakfast, Welcome dinner, Conference materials, transport to and from hotels, airport pick up, cultural evening, morning tea, lunch and evening tea.
# Welcome dinner, Conference materials, transport to and from hotels, airport pick up, cultural evening, morning tea, lunch and evening tea. Accommodation will be arranged at extra cost.
+ Includes everything except conference materials.

Please send information on exhibiting and opportunities to present workshops.

STEP 2. Payment Information

- By bank draft in favour of “Convener, Stem Cells 05” on any bank in Bhubaneswar, India - By direct credit or by credit card to Convener, Stem Cells 05, A/C No. : 380801010035120, Union Bank Of India, Main Branch, Bhubaneswar (SWIFT CODE : UBININBBABNW in case of remittance from outside India). In case of credit card payment, write the name as it appears on the card, card number and the expiration date. Payment details including transaction ID must be sent along with the registration request.

Please write a check to: “Convener, Stemcells05” and send to the following address :
Mr. B.K. Singh,
Imgenex India Pvt. Ltd.
E-5 Infocity
KIIT Post office
Bhubaneswar- 751024
Copyright © 2005 stemcells05.org