Conference Registration Form - icomp-2015

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Conference Registration Form - icomp-2015
International Conference on Medicinal
Plants: Resource for Affordable New
Generation Healthcare 2015
Please complete and return this form along with payment to:
Director
International Conference on Medicinal Plants: Resource for Affordable New Generation Healthcare 2015,
CSIR – Central Institute of Medicinal and Aromatic Plants,P.O. CIMAP, Lucknow - 226015, U.P.,India
Phone : +91-522-2718634, 2718590 Fax : +91-522-271907
Email:[email protected]; [email protected]
CONFERENCE
REGISTRATION FORM
The preferred method of registration
is via the web at
http://icomp.cimap.res.in
Important notes
 Please send scanned copies of all
pages to mail id :
[email protected]
 Please keep a photocopy for your
record.
 One form per person (photocopies
accepted).
Contact details
Mr
Ms
Mrs
Miss
Dr
Other (please
specify)
Prof.
Last name
First name
Organisation
Position
Address
Suburb/Town
State
Country
Work phone
(
)
Work fax
Postcode
(
)
Mobile
Email
Role at conference
Delegate
Accompanying Person
Accompanying person details
Mr
Ms
Mrs
Miss
Dr
Last name
Other (please
specify)
Prof.
First name
Organisation
Position
Address
Suburb/Town
State
Work phone
Country
(
)
Work fax
Postcode
(
)
Mobile
Email
How did you find out about the conference
Colleague told me
Website search
Direct email notification
Workplace notice board
Received information in the mail
Other– please specify
ICOMP 2015
Conference registration
Registration fee is per person and includes attendance to the conference, morning tea, and lunch, afternoon tea,Welcome Reception, Conference Dinner
and conference materials.
Registration type
Faculty/Scientists/Industry Participants
Students
Accompanying Person
Exhibition Booth
Foreign Delegates
Early bird rate
Late & on spot registrations
(till 25 January 2015)
Rs 3000
Rs 2500
Rs 2000
Rs 15000
$150
(after 25 January 2015)
Rs 4000
Rs 3500
Rs 3000
Rs 25000
$250
Accommodation – Hotel options
The conference office has secured competitive rates for delegates at selected hotels in Lucknow, to suit a range of budgets and preferences.
Accommodation facilities are easily accessible to the conference venue, and will provide a comfortable and enjoyable stay for delegates.
Rooms can be booked through the conference office up until 28 February 2015. After this date bookings are subject to availability.
To secure an accommodation booking, indicate your preference below. Please note payments are to be made separately in advance to secure
accommodation.
The conference organisers will not provide conveyance facilities for delegates making their own stay arrangements during the conference .
PLEASE NOTE
Due to a large international conference in Lucknow on the same dates as the ICOMP-2015 conference, Lucknow
hotel rooms are limited so please book early. For any dates outside the conference you need to contact the conference
office on [email protected]
Please mark your preference numerically in sequential order.
Rate – room inclusive of taxes & breakfast
Rates per room per night per person on double sharing basis
Hotel/Hostel
5 Star Hotel
Rs 4500
3 Star Hotel
Rs 2250
Budget Hotel Luxury
Rs 1300
Budget Hotel Deluxe
Rs 1200
Hostel (For student delegates only)
Rs 200 per person
Booking details
No. of occupants per room
If greater occupancy per room is required than that indicated by bed nos, extra fees may apply.
Arrival date
2015
Arrival time
AM / PM
Departure date
2015
Departure time
AM / PM
ICOMP 2015
Payment
All payments must be made in Indian Rupees only and for foreign participant, the fees has to be paid in US$.
Conference Registration Fees
Rs
Method of payment
Demand Draft - Send demand
draft to the conference office
Multicity Cheques - Send
crossed cheque to the conference
office
Demand Draft Details:
DD No:
Amount :
Issue Date :
Issuing Bank
Place:
Demand Draft and Cheques must be in favour of “The Director, Central
Institute of Medicinal and Aromatic Plants” payable at Lucknow, Uttar
Pradesh, India and may be sent along with the registration form by speed
post/courier at the following address:
Multicity Cheque Details:
Cheque No:
Amount :
Issue Date:
Issuing Bank:
Place:
Director,
CSIR – Central Institute of Medicinal and Aromatic Plants,
Near Kukrail Picnic Spot Road, P.O. CIMAP,
Lucknow - 226015, Uttar Pradesh, India
Bank transfer - when sending a bank transfer, please send a
remittance advice to the conference office via email to
[email protected]; [email protected] or by fax to +91-522271907
Name of the Bank : State Bank of India, Main Branch, Lucknow
Bank Branch Code No. : 0125
IFSC code (for transfer within India) : SBIN0000125
SWIFT code (for international transfers) : SBININBB157
Recipient's Name : Central Institute of Medicinal and Aromatic Plants
Recipient's Account Number : 30267691783
RTGS : SBIN0000125
All bank fees must be covered by the delegate
DECLARATION
I have read and understood the terms & conditions.
Signature: ______________________________________________
ICOMP 2015