Online registration for METAA 4th Aortic Summit – 8th and 9th, JAN 2011

Name*

Gender*

Qualification*

Residential Address*

Pincode*

City*

State*

Country

Phone*

Fax

Hospital Address*

Pincode*

City*

State*

Country

Phone*

Fax

eMail*

Cheque / DD details
(if you have the details)

* Preferred address for all correspondence
(Please select one)

Note

• Registration Fee : Rs.2000/-

• Cheque / Demand Draft in favour of : MIOT Hospitals Limited (Payable at Chennai).
  To register, fill this online registration form and send a DD / Cheque for Rs. 2000/- made out to MIOT Hospitals Limited, payable in Chennai. Also please mention your name, contact number, and your registration id (which you will see after submitting this form and also receive as an email to your registered id) in a separate sheet along with the DD/Cheque that you courier to us.
  Mailing address
  Dr. K. Murali – METAA Organizing Secretary
  MIOT Hospitals, 4/112, Mount Poonamalle Road , Manapakkam
  Chennai - 600 089, Tamil Nadu, INDIA.

• Last date for receipt of application and DD/Cheque for the programme: Dec 28, 2010.