Course on ECG in 4 Hours

Course on ECG in 4 Hours
Organised by TACVI, Hyderabad
Registration Form
-----------------------------------------------------------------------------------------
Dates: 16th November 2014
Venue: Hotel Taj Banjara, Banjara Hills
Time: 9.30am-2pm
To,
Dr. C. Raghu, Course Director
Name (In Block Letters)
Title
First Name
Speciality
Gender
Last Name
Gender
Institute
Email ID (Mandatory)
Mobile No: ______________________ Ph No.: ________________STD Code:_______
Address:
Registration:
Registration Fees
Rs 1500
Please register me as a _________________, for ECG Course. I enclose here the fee vide NEFT/RTGS/Cash
/Cheque / DD No. : _______________________ dated ____________ for an amount of
Rs.______________________ in favour of “Training Academy for Cardiovascular Interventions”.
Signature
For Direct Deposits & NEFT / RTGS Fund Transfer:
Indian Overseas Bank , Srinager Colony Branch
Account: Training Academy for Cardiovascular Interventions
Account No. 189002000000140
IFSC Code: IOBA 0001890
Please send the filled form to:
Dr. C. Raghu, Cocoon Management Consltnts
Roshan Basera, 10-5-8/8/A/2,
Nr Canara Bank, Khaja Mansion Rd.
Masabtank, 500028, Hyderabad, A. P.
Ph: 09989335361, 09246105361
Write to us at:
[email protected]
www.interventionaltraining.com
[email protected]
www.cocoonconsultants.com
--------------------------------------------------------------------------------------------------------------------------For office use only: Amount received Rs._____________ ______________Cash/Cheque/DD No.________________
dated ____________. Receipt No. _____________ Registration No.___________.
Course Managed by
Cocoon Management Consultants
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