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ONLINE REGISTRATION FORM
High income countries
*Your membership status will be verified from the list provided by IPRAS
*Choose 'Others' in the Country drop down Menu if your country is not listed as an IPRAS Member
who are members of IPRAS
*
Compulsory fields
Category
*
Select a Category
Faculty
Physician
Student
Nurse
Name
*
Prof.
Dr.
Mr.
Ms.
Last name
Initial
First name
Sex
:
Male
Female
Mailing Address
*
City
*
Postal code
*
State
*
Country
*
Select
Australia
Austria
Bahrain
Belgium
Brazil
Canada
Cyprus
Denmark
Finland
France
Germany
Greece
Hong Kong
Iceland
Ireland
Israel
Italy
Japan
Korea (South)
Kuwait
Libya
Luxembourg
Netherlands
New Zealand
Norway
Oman
Portugal
Puerto Rico
Saudi Arabia
Singapore
Spain
Sweden
Switzerland
Syria
United Arab Emirates
United Kingdom
United States
Uruguay
Others
Institution
*
E mail-1
*
E mail-2
Telephones
Country code
City code
Number
Residence
Office
*
Fax
Mobile
Passport Details
Number
*
Place of issue
*
Date of issue
*
Date of Expiry
*
Accompanying Persons
Number
0
1
Category
1
2
Name
Relation
Select
Spouse
Child
Passport Details
Number
Place of issue
Date of issue
Date of Expiry
Payment Details ( fill amount in Rs.)
Delegate
*
Accompanying Persons
Gala Party
Accommodation Advance
Travel & Tour
Master Class/HID
Total Amount
Separate forms for Gala Party , Travel & Tours, Master Class & Accommodation need to be filled.
All money transfer cost toward 'Tour & Accommodation' will be borne by the delegate.
I agree to accept the terms and conditions
*
29th november - 3rd december 2009
hotel ashok, new delhi
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