Online Registration

43rd Annual Conference of

RESEARCH SOCIETY FOR
THE STUDY OF DIABETES IN INDIA

“Bring back “sugar�? in your life…..smile as you are in Lucknow�?

REGISTRATION FORM
(* Mandatory Fields)

DELEGATE DETAILS

Title*
Full Name*
Postal Address*
Country*
Mobile No.*
Telephone No.
E-mail*
Age*
Gender*
   
Food Preference*
   
Medical council registration No.
RSSDI Membership No.

Passport Details (Only for Foreign Delegates as per Ministry of Home Affair’s guidelines)

Passport No.
Father’s/ Husband Name
Place of Issue
Date of Issue
Date of Expiry
Date of Birth
Place of Birth
Nationality

Accompanying Person Details

Title
Full Name
Age
Gender
   
Food Preference
   
Relationship

Passport Details (Only for Foreign Delegates as per Ministry of Home Affair’s guidelines)

Passport No.
Father’s/ Husband Name
Place of Issue
Date of Issue
Date of Expiry
Date of Birth
Place of Birth
Nationality

Accompanying Person Fee Details

Category Pehle Aap Upto 23.11.14 Warm up Upto 31.03.15 Brisk Walker's Upto 31.07.15 Late Riser's Upto 30.09.15
Accompanying Person 4000 6000 8000 10000
Foreign Accompanying 250 USD 350 USD 400 USD 450 USD

Registration Fee Details

 
Category Pehle Aap Upto 23.11.14 Warm up Upto 31.03.15 Brisk Walker's Upto 31.07.15 Late Riser's Upto 30.09.15 Walk in Upto 01.11.15
6000 9000 10000 12000 15000
7000 10000 12000 15000 18000
2000 3500 4000 5000 6000
10000 12500 14000 15000 18000
300 USD 400 USD 450 USD 500 USD 600 USD

ACCOMMODATION DETAILS

Accommodation Facilitaion:    
For more details related to accommodation, please contact the Secretariat as per below details:
Dr. Anuj Maheshwari
Organizing Secretary, RSSDI – 2015
RSSDI Sacretariat
Sri Hari Kamal Diabetes Clinic & Research Center
Jeevan Sahara Tower, Vikas Nagar
Lucknow-226022
Tel: 0522-4024878 Email: rssdi2015@gmail.com
Mob: +91-8874111138 Website: www.rssdi2015.com
Email and Mobile no. is compulsory for Registration. All communication will be sent through Email/SMS only.
Registration Fees Rs.
Accompanying Person Fees Rs.
Total Fees Rs.
   

PAYMENT DETAILS

Mode of payment:
     
Cheque/DD/UTR no.
(Cheque/DD to be drawn in favour of "Concept Conferences Pvt Ltd" Payable in Delhi)
Branch:
Registration Ammount:
Accompanying Persion Amount:
Total Amount paid:

INSTRUCTIONS FOR REGISTRATION

  • We prefer you to do the online registration from our website www.rssdi2015.com after making the payment online through Net banking or by providing the DD/Cheque details.
  • If you are NOT comfortable in doing online registration, you can always send us the filled and signed registration form along with the payment details (DD/Cheque/UTR No) to the conference secretariat address.
  • PG students should attach a certificate from their HOD/Institution.
  • Cancellation Process
    • Cancellation sent upto 30th June 2015, will get a refund of 50% of registration fee.
    • Cancellation after 30th June 2015, will get a refund of 25% of registration fee.
    • Refunds of cancellation will be initiated after the completion of the conference.
  • Please fill the form in CAPITALS only.