19 th MIDCOMS-2015 AOMSI Midterm Conference & 5 th PG Convention th th 09 – 11 July 2015, Vijayawada, Andhra Pradesh. REGISTRATION FORM Date: AOMSI Membership No. Name : Photo Address : City : State: Pin Code : Ph : Mobile : Email : Accompanying Person(s) Name: Age: Gender : Relation : Registration Details Category UPTO Jan 31 st UPTO March 30 th UPTO June 15 th ON-SITE *Delegates Rs. 4000 Rs. 4500 Rs. 5000 *Delegates (Non-Member) Rs. 5000 Rs. 5500 Rs. 6000 Rs. 7000 **PG Trainees Rs. 3000 Rs. 3500 Rs. 4000 Rs. 5000 **PG Trainees (Non-Member) Rs. 4000 Rs. 4500 Rs. 5000 Rs. 6000 ***Accompanying Persons Rs. 3000 Rs. 3500 Rs. 4000 Rs. 4000 * International Delegates 100 USD 150 USD 200 USD 200 USD Rs. 6000 * Registration kit, Two Lunches, Inaugural Dinner, Gala Banquet, Gift, Entry to Scientific Sessions & Trade Exhibition ** Registration kit, Two Lunches, Inaugural High tea, Gala Banquet, Entry to Scientific Sessions & Trade Exhibition *** Two Lunches, Gala Banquet, Entry to Trade Exhibition
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