September 3rd-4th, 2015 @ AIMS
Kochi, Kerala
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AETCM
Presidential Message
Committee
Conference
Faculty
About
Contact
AELS Registration
Prefix
Dr.
Prof.
Mr.
Mrs.
Ms.
Name
Age
Sex
Male
Female
Address
Email
Phone
Institution
Designation
Nationality
Category
Doctor/Faculty/Consultant
Postgraduates / Interns / Paramedics
Trade Representative
Amount*
Payment Type
Demand Draft
NEFT/RTGS
Number
Date
Bank/Branch
In Favor of
Bank
Branch
Account Type
Account Number
IFSC Code
Kindly attach a copy of your institutional ID with the registration form
Please send the duly-filled registration form along with the DD to:
Conference Secretariat - AELS 2015
Department of Emergency Medicine
Amrita Institute of Medical Sciences
Ponekkara (PO), Cochin - 682041, Kerala, India.
Tel # 09496339347/04842856041
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