Theory and Practice of Epidemiology and Biostatistics 2019
Registration form
Name of Participant *
Your answer
Your answer
Name of the Institution
Your answer
Do you have a Medical Council Registration number ? *
If yes, please fill in the Medical Council Registration number and respective medical council below (eg 76890, Karnataka)
Your answer
Contact Address
Your answer
Telephone number *
Your answer
E-mail ID *
Your answer
Accommodation required
If yes, please tick choice
Agreeable to sharing room
Food preference (Participants who wish to bring own lunch during the course can pay Rs 2000/- less towards the fee)
If yes
Two main expectations from the workshop
Your answer
Will you be attending 1-day demography course?
Transaction ID of bank transfer made or DD no
Your answer
Important notes on registration
1. A separate registration form needs to be filled for each participant
2. Course fees
Before 12th June: Rs.8000/-(For Students) & 12000/- for Faculty. [After 12th June: Rs 12,000/- (for students) & Rs
17,000/- (for faculty) (plus 18% GST applicable on all fees)
2. Participants wishing to attend the 1-day demography course need to pay additional Rs 1000/- towards registration fee
3. Participants who wish to bring own lunch during the course can pay Rs 2000/- less towards the fee
4. For further clarification kindly contact Jeeva/Kavya, Telephone: 080-49467000 Ext-7030/7050
Contact for further enquiry
Dr Prem K. Mony, M.D.
Course Director
Head, Division of Epidemiology & Population Health
St. John’s Research Institute
Bangalore – 560034

Dr Tinku Thomas, PhD
Course Coordinator
Head, Biostatistics Unit
St. John’s Research Institute
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service