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Registration Form
Delegate Fee: Please tick the relevant category:
Download Registration Form
Rs. 3000/- Per Person Inclusive of all Taxes
The following participants (s) would attend
Name
Designation
1.
2.
3.
4.
5.
For additional nominations, please use a photocopy of this form
Billing Details
Enclosed please find
Cheque/DD no.
Dated
Drawn on
For Rs.
In favour of
“Wockhardt Foundation”
towards delegate fee.
Nominated By:
Name:
Designation:
Company:
Address:
City:
Pincode:
Office No:
Mobile No:
Fax:
E-Mail:
Signature:
Date:
Note: Since there are limited seats, Pre-Registration is a must
Sunali Y Kothari
Conference Secretariat
Jai Mumbai 2009
Wockhardt Towers, Bandra Kurla Complex,
Bandra(East).
Mumbai-400 051
INDIA.
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