12th International Double Stranded RNA Virus Symposium
Transcription
12th International Double Stranded RNA Virus Symposium
12th International Double Stranded RNA Virus Symposium 6-10 October, 2015, Goa, India REGISTRATION&HOTELBOOKINGFORM DelegateDetails Title: ☐Dr☐Prof☐Mr☐Ms☐Mrs FirstName:_________________________________LastName:_________________________________Gender:☐M☐F Organiza on:______________________________________________________Posi on:______________________________ PostalAddress:__________________________________________________________________________________________ Suburb/City:_______________State(Province):_______________Postcode:________Country:_______________________ WorkPhone:_________________Mobile:_________________Email:_____________________________________________ ForInterna onalDelegatesOnly PassportNumber:________________DateofIssue:______________________(dd/mm/yyyy) ExpiryDate:_____________________(dd/mm/yyyy)PlaceofBirth:_____________________________________________ AccompanyingFamilyPersonDetails(Incaseofaddi onalnames,theformmaybephotocopied) ☐Dr☐Prof☐Mr☐Ms☐Mrs GivenName:________________________________________FamilyName:_______________________________________ ForInterna onalAccompanyingFamilyPersonsOnly PassportNumber:_______________DateofIssuing:________________(dd/mm/yyyy) ExpiryDate:______________________(dd/mm/yyyy)PlaceofBirth:___________________________________________ Registra onFees(Please cktherelevantboxbelow) Registra onType BeforeAugust10,2015 Interna onalDelegate ☐ USD300 ☐ USD415 Interna onalAccompanyingFamilyPerson ☐ USD150 ☐ USD210 IndianDelegate ☐ INR9400 ☐ INR11725 IndianAccompanyingFamilyPerson ☐ INR5000 ☐ INR6000 DelegateRegistra onfeeIncludes: Mee ngliterature&accesstoallScien ficSessions. Tea/coffeeandlunchonallsymposiumdaysattheSymposium venue. Dinner at a specified loca on in the hotel on all days, except October9th.AnoffsitesocialeveningisbeingarrangedonFriday, October9th.Delegateswhodonotwishtopar cipateinthisevent are requested to make their own dinner arrangements on this date. Theregistra onfeeincludesallcurrentlyapplicabletaxes.Iftaxes imposedbytheGovt.ofIndiachange,anaddi onalfeemaybe charged. August11,2015Onwards AccompanyingFamilyPersonRegistra onfeeIncludes: Tea/coffeeandlunchonallsymposiumdaysattheSymposium venue. Dinnerat a specifiedloca on in the hotelon alldays, except October 9th. An offsite social evening is being arranged on Friday,October9th.Personswhodonotwishtopar cipatein thiseventarerequestedtomaketheirowndinnerarrangements onthisdate. The registra on fee includes all currently applicable taxes. If taxesimposedbytheGovt.ofIndiachange,anaddi onalfee maybecharged. HotelAccommoda on(GoaMarrio Resort&Spa) RoomType Special Rate per Night (INR) SingleRoom ☐ 12,700 Twinsharingroomwithsomeoneallo edbytheSecretariat ☐ 6350 per person TwinsharingroomwithSharedwithpersoniden fiedbyyou ☐ 12,700 for two persons Sharer Name:____________________________________________________________________________________________ Pleasespecifydietaryrequirement:☐Veg ☐Non-Veg ☐Allergiesifany,specify:_________________________________ TheSpecialRateincludes: Buffetbreakfast Allcurrentlyapplicabletaxes Check-inDate:________________Check-outDate:_________________ Totalno.ofNights:_____________TotalAmount:__________________ PaymentOp ons ☐ DemandDra :(OnlyforIndianPar cipants)–PaymentscanbemadebyaDemandDra favouring “KWConferencesPvtLtd”,payableatNewDelhiandsentthroughcouriertothebelowmen onedaddress: (Event:dsRNA2015)KWConferencesPvt.Ltd. A-56/12,DLFPhase-I,Gurgaon-122002,Haryana,India,Tel.:+911244636700/722 PleasewriteDelegateNameinBLOCKLETTERSatthebackoftheDemandDra .Anemailwillbesentuponreceiptofthe registra onfee. ☐CreditCard:MasterCardorVISA(forOnlineRegistra ononly) ☐ BankTransfer:Kindlymen onyourName,ConferencenameandyourRegistra onIDnumberonthetransfertolocatethe payment.Also,pleasesendustheremi anceadviceorreceipttotracethepaymentatregistra [email protected] NameofBank : AxisBankLtd AccountNumber : 357010200000578 AccountHolder : KWCONFERENCESPVT.LTD. IFSCode : UTIB0000357 SWIFTCode : AXISINBB357 BankAddress : B–81,DefenceColonyNewDelhi–110024India BookingCancella onandRefundPolicy Registra on: 1. Requestsforcancella onofregistra onreceivedinwri ngbytheconferencesecretariatatregistra [email protected] a ertheSymposiumatthefollowingrates: -Onorbefore20August2015-Fullfeeminus25%cancella oncharges. -A er20August2015:Norefundcanbemadealthoughanalternateregistrantcanbesubs tutedun lOctober1,2015. 2. Allrefundswillbemadewithin60daysa ertheSymposium. ImportantNote:Dateofreceiptofcommunica onforcancella onwillbeusedforcalcula ngtheamountofrefund.Refundswillbecredited onlytotheaccountfromwhereregistra onwasreceived. HotelAccommoda on: 1. Reserva onofhotelroomsrequiresadvancepaymentforthetotaldura onofstay. 2. Requestsforcancella onsorchangesfromtheoriginalbookingmustbedirectedviaemailtohotels@dsrna2015.org.Pleasedonotcontact thehoteldirectlyasthisbookingismadeataspecialrate. 3. Forcancella onsreceivedonorbefore20August,2015theen rebookingamountforaccommoda onwillberefunded,a erdeduc ng banktransac oncharges,applicabletaxesandanadministra vefeeofINR500. 4. Forcancella onsreceiveda er20August,2015norefundswillbemade.Incaseofchangeindatesofarrivalanddeparturereceiveda er20 August,2015,therewillbenorefund.Addi onally,norefundswillbeapplicableincaseoflatecheck-inorearlycheck-out. 5. Allrefundswillbemadewithin60daysa ertheSymposium. Iagreewiththeaboveterms. Delegate’sSignature___________________________________Date:____________________ Please courier the filled in Registra on Form along with Payment to: dsRNA2015 KWConferencesPvt.Ltd.,A-56/12,DLFPhase-I,Gurgaon-122002India Ph:+911244636700/722Fax:+911244102075,Email:registra [email protected] PLEASENOTE:REGISTRATIONWILLBECONFIRMEDONRECEIPTOFPAYMENTONLY