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REGISTRATION FORM 13th Annual National Conference of Breast Cancer Foundation – India 7th and 8th March 2009 Name……………………………………………………………………………….. Delegate Postgraduate

(Certificate from HOD to be enclosed)

Mailing Address: ……………………………………………………………………

City…………………………………………………………………………………… Pin…………………………………………………………………………………….. Telephone…………………………………. Hospital………………………………… Mobile…………………………………………………………………………………. E-mail………………………………………………………………………………….. Veg.

Non. Veg.

Accommodation required

Yes

No

Registration Fees………………………………………… P.G.Student…………………………………… (Certificate from HOD) Accommodation (1 day rent) in advance Total Rs……………………………………………………………………………………. PAYMENT DETAILS Enclosed DD/Cheque for Rs………………………….Cheque/DD No…………………… Dated……………………………………………Bank…………………………………….. (Demand Draft favoring BRECON 2009 payable at Madurai) (Add Rs. 30 for out station cheques) Completed form to be sent to Conference Secretariat BRECON – 2009 Dept. of Radiation Oncology Meenakshi Mission Hospital and Research Centre Lake Area, Melur Road, Madurai – 625 107, Tamil Nadu E-mail: mmhrcbrecon2009@rediffmail.com


Madurai Medical Journal January 09  

The Madurai Medical Journal is being published by IMA Madurai Meenakshi Branch

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