16 International Neurology Update 2016, Registration Form
Thursday-Sunday, December, 22-25, 2016, Moven Pick Hotel Karachi, Pakistan
* Required
Email address
*
Your email
Name
*
Your answer
Institution
Your answer
Specialty
Your answer
Mailing Address
*
Your answer
Phone Residence
Your answer
Phone Clinic
Your answer
Cell
*
Your answer
Note:
Physiotherapist (PT), Occupational Therapist (OT), Speech Therapist (ST), Psychologist (PY), NP Tech. / PG’s/ Resident/ HO’s & Medical Student will have to submit valid ID & original letter from HOD about their status with the registration form.
Choose the following and pay accordingly
Consultant / Family Physician: Rs.6,500/=
Workshop Only: Rs. 1,500/=
Post graduate Trainee: Rs.1,500/=
PT/ST/OT & PY: Rs.1,500/=
Neurophysiology Technologist: Rs. 1,500/=
House Officers & Med. Students: Rs. 850/=
Corporate: Rs. 8,000/=
Accompany Person (under age 10 is free): Rs. 7,500/=
Clear selection
Online/Bank
In Person
Clear selection
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms