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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

Madurai Medical Journal January 09  

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

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