Registration Form

CT CME 2004

16^th and 17^th October 2004

Name:

Institution:

Postal Address:

Post code

Phone:

Mobile:

E Mail:

I enclose a Bank Draft (number…..………..) for Rs. 500/- dated drawn on ……………… Bank payable at Coimbatore for registration for the course

I also enclose a Bank Draft (number…..………..) for Rs. …….. dated drawn on ……………… Bank payable at Coimbatore for accomodation

Signature