International Conference on Medicinal Plants: Resource for Affordable New Generation Healthcare 2015 Please complete and return this form along with payment to: Director International Conference on Medicinal Plants: Resource for Affordable New Generation Healthcare 2015, CSIR – Central Institute of Medicinal and Aromatic Plants,P.O. CIMAP, Lucknow - 226015, U.P.,India Phone : +91-522-2718634, 2718590 Fax : +91-522-271907 Email:icomp@cimap.res.in; icomp2015@gmail.com CONFERENCE REGISTRATION FORM The preferred method of registration is via the web at http://icomp.cimap.res.in Important notes Please send scanned copies of all pages to mail id : icomp.registration@cimap.res.in Please keep a photocopy for your record. One form per person (photocopies accepted). Contact details Mr Ms Mrs Miss Dr Other (please specify) Prof. Last name First name Organisation Position Address Suburb/Town State Country Work phone ( ) Work fax Postcode ( ) Mobile Email Role at conference Delegate Accompanying Person Accompanying person details Mr Ms Mrs Miss Dr Last name Other (please specify) Prof. First name Organisation Position Address Suburb/Town State Work phone Country ( ) Work fax Postcode ( ) Mobile Email How did you find out about the conference Colleague told me Website search Direct email notification Workplace notice board Received information in the mail Other– please specify ICOMP 2015 Conference registration Registration fee is per person and includes attendance to the conference, morning tea, and lunch, afternoon tea,Welcome Reception, Conference Dinner and conference materials. Registration type Faculty/Scientists/Industry Participants Students Accompanying Person Exhibition Booth Foreign Delegates Early bird rate Late & on spot registrations (till 25 January 2015) Rs 3000 Rs 2500 Rs 2000 Rs 15000 $150 (after 25 January 2015) Rs 4000 Rs 3500 Rs 3000 Rs 25000 $250 Accommodation – Hotel options The conference office has secured competitive rates for delegates at selected hotels in Lucknow, to suit a range of budgets and preferences. Accommodation facilities are easily accessible to the conference venue, and will provide a comfortable and enjoyable stay for delegates. Rooms can be booked through the conference office up until 28 February 2015. After this date bookings are subject to availability. To secure an accommodation booking, indicate your preference below. Please note payments are to be made separately in advance to secure accommodation. The conference organisers will not provide conveyance facilities for delegates making their own stay arrangements during the conference . PLEASE NOTE Due to a large international conference in Lucknow on the same dates as the ICOMP-2015 conference, Lucknow hotel rooms are limited so please book early. For any dates outside the conference you need to contact the conference office on accommodation@cimap.res.in Please mark your preference numerically in sequential order. Rate – room inclusive of taxes & breakfast Rates per room per night per person on double sharing basis Hotel/Hostel 5 Star Hotel Rs 4500 3 Star Hotel Rs 2250 Budget Hotel Luxury Rs 1300 Budget Hotel Deluxe Rs 1200 Hostel (For student delegates only) Rs 200 per person Booking details No. of occupants per room If greater occupancy per room is required than that indicated by bed nos, extra fees may apply. Arrival date 2015 Arrival time AM / PM Departure date 2015 Departure time AM / PM ICOMP 2015 Payment All payments must be made in Indian Rupees only and for foreign participant, the fees has to be paid in US$. Conference Registration Fees Rs Method of payment Demand Draft - Send demand draft to the conference office Multicity Cheques - Send crossed cheque to the conference office Demand Draft Details: DD No: Amount : Issue Date : Issuing Bank Place: Demand Draft and Cheques must be in favour of “The Director, Central Institute of Medicinal and Aromatic Plants” payable at Lucknow, Uttar Pradesh, India and may be sent along with the registration form by speed post/courier at the following address: Multicity Cheque Details: Cheque No: Amount : Issue Date: Issuing Bank: Place: Director, CSIR – Central Institute of Medicinal and Aromatic Plants, Near Kukrail Picnic Spot Road, P.O. CIMAP, Lucknow - 226015, Uttar Pradesh, India Bank transfer - when sending a bank transfer, please send a remittance advice to the conference office via email to icomp@cimap.res.in; icomp2015@gmail.com or by fax to +91-522271907 Name of the Bank : State Bank of India, Main Branch, Lucknow Bank Branch Code No. : 0125 IFSC code (for transfer within India) : SBIN0000125 SWIFT code (for international transfers) : SBININBB157 Recipient's Name : Central Institute of Medicinal and Aromatic Plants Recipient's Account Number : 30267691783 RTGS : SBIN0000125 All bank fees must be covered by the delegate DECLARATION I have read and understood the terms & conditions. Signature: ______________________________________________ ICOMP 2015
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