IDA 2001 - Registration Form

REGISTRATION FORM

For printable format of the Registration Form Click Here

Guidelines for Submission of the Registration Form Click Here

For printable format of the Annual Membership Click Here

For printable format of the Student Membership Click Here

PERSONAL INFORMATION
Prefix *
Name *
	First Name Middle Name Last Name
Qualification *
IDA Membership Number
Mailing Address *
City *
Country *
Pin/Zip Code
Tel. Home
Tel. Office
Mobile
Fax
E-mail *

CONFERENCE
Are you presenting a Scientific Paper		Yes No
Please Select		Till 15th Dec 2001
	Delegate with Hospitality (includes Lunch & Tea)	Rs. 1000
	Hospitality for Spouse	Rs. 800
	Hospitality for Children under the age of 12	Rs. 500
	Delegate	Rs. 200
	Student Delegate with Hospitality	Rs. 500
	Banquet	Rs. 500

Name of Accompanying Person (s)
1.		2.
3.		4.

PRE-CONFERENCE DETAILS

PLEASE TICK THE APPROPRIATE COURSES FOR WHICH YOU ARE WILLING TO REGISTER

Course Name	Course Conductor	Venue	Registration Time	Course Start Time	Registration Fee	Select One
Introduction to fixed Prosthodontics	Dr. T.V. Padmanabhan	Saveetha Dental College and Hospital	8.00 am	9.00 am	Free
Endodontic Update	Dr. A. Parameswaran	Meenakshi ammal Dental College and Hospital	8.00 am	9.00 am	Free
Aesthetic Restorative Dentistry Update	Dr. V.G. Sukumar	SRM Dental College and Hospital	8.00 am	9.00 am	Free
Management of Medical Emergencies in the Dental Office	Dr. M. Baskar	Sri Ramachandra Dental College and Hospital	8.00 am	9.00 am	Free
Composite "Swayamvaram"	Dr. D. Kandaswamy	The Tamil Nadu Govt. Dental College	8.00 am	9.00 am	Free
Composite Resin Inlays and Pediatric Dentistry Update	Dr. R. Gunaseelan	Ragas Dental College	8.00 am	9.00 am	Free

ACCOMMODATION DETAILS

COMPLETE PAYMENT FOR ACCOMMODATION REQUIRED

Online Registration Fee of Rs. 150 will be charged