.

Register

REGISTERATION FORM FOR 13 th ANNUAL CONFERENCE


VISION 2020: The Right to Sight – INDIA
13 th Annual Conference
Inclusive Eye Care Services
3 rd & 4 th June, 2017
MGM Eye Institute, Raipur, Chhattisgarh


Part – A

Name (required)

Gender

Designation

Organisation

Address

Your Email (required)

Phone (Landline)

Mobile

The Courses I would like to attend

 Organisational Development
 Eye Care Delivery to the Unreached
 Improving Patient Outcomes in Cataract Surgery
 Skill Enhancement for Optometry & Ophthalmic Assistants

Note: delegates can chose more than one track. The selection will not limit them to attending that track only. This is only for our planning purpose.



Registration Fees Details

Dates Fee for VISION 2020 – INDIA Members Fee for Non-Members
Upto 30 April 2017 Rs.1000 Rs.1300
Upto 2 June 2017 Rs.1300 Rs.1600
On the spot registration Rs.1700 Rs.2000
Students will enjoy a subsidised fee of Rs.500 whichever dates they apply.
We will request the students to submit a copy of their I- card while registering to benefit from the discounted rate.

*Note: the registration charge is for per person only.

Part -B
Mode of Payment

Please choose any one method of payment and tick the appropriate one.

 In case payment is through DD/ Cheque, please enclose it along with the registration form. See address details below.


Date of DD/Cheque:

Amount

Bank Name drawn from

Branch Name drawn from:

 In case payment is made through wire transfer

Direct wire remittance A/c No: 540901010050883
o NEFT / IFSC Code : UBIN0554090
o Bank Name : UNION BANK OF INDIA
o Branch : SHANKAR NAGAR, RAIPUR
o MICR : 492026007

Date payment made

Amount paid

Bank Name

Branch Name

Other Wire transfer details:

 For spot registration: Delegates can pay either by cash or DD drawn in favour of “MGM EYE INSTITUTE VISION 2020 CONFERENCE” payable at Shankar Nagar, Raipur



Please send your completed registration forms and Demand Draft/Cheque to:
Sub: 13th Annual Conference-VISION 2020 INDIA

MGM Eye Institute
5th Mile Vidhan Sabha Road
Saddu, Raipur – 493111, Chhattisgarh

Mail id: infov2020@mgmeye.org
Phone: +919589837232, 0771-2970690.


For any further information, contact:
Conference Secretariat :

VISION 2020: The Right to Sight – INDIA
D-21, Corporate Park, 2 nd floor,
Sector-21, near Sector 8 Metro Station
Dwarka, New Delhi – 110 077

Telephone: +91- 11 6565 0577
E mail:   sridevi@vision2020india.org


Download Registration Form

 

Students will enjoy a subsidised fee of Rs.500 whichever dates they apply.
We will request the students to submit a copy of their I- card while registering to benefit from the discounted rate.