S S U MIT 18 O B Bossummit with a difference ITC Gardenia, Bangalore · Hospital / Institution: _____ Mailing Address: ... • Registration Fee includes Delegate Kit, Admission to

BOS S

UMMIT 2018Bossummit with a difference

Under the aegis of KOS

Name*: ______________________________________________________________________________________________________

Age: ___________ Sex: M F

Hospital / Institution: ________________________________________________________________________________________

Mailing Address: ____________________________________________________________________________________________

____________________________________________________________________________________________

Mobile No*: ___________________________________ Email*: _______________________________________________________

BOS Member KOS Member Membership No._________________ Others Fellow / Post Graduate

KMC / Other Medical Council No*: _______________________________________ Food Preference: Veg Non-Veg

*Mandatory fields to be filled

Please find enclosed Rs.__________________________, in words ________________________________________________

By Cheque/DD No.______________________ dated ______________ drawn on ___________________________________

Signature of Participant

REgiStRAtiON FEES

Early Bird up to April 30th, 2018

Late Fee up to June 5th, 2018

Spot Registration

BOS / KOS Members / Others

` 3,000 ` 3,750 ` 4,250

PG / Fellows ` 2,000 ` 2,500 ` 3,000

• PG/Fellows:LetterfromHOD/InstituteandacopyofIDCardisnecessary• RegistrationFeeincludesDelegateKit,AdmissiontoScientific/TradeExhibitions,Lunch

andCoffee• SpotRegistrationDelegatesareNOTELIGIBLEforCMECreditHours(NewKMCrules)• CMECreditHourssubjecttoattendanceofentireprogrammefor2days• Certificateswillbeissuedat5.00pmonlytodelegateswhoregisterbeforeJune5th,2018• Norefundswillbemadeforcancellations• Useoneformforeachregistration

23rd and 24th June, 2018, ITC Gardenia, Bangalore

For queries contact: 9342935370 / [email protected] / [email protected]

MOdE OF PAyMENt•DD/Chequeinfavourof

“Bangalore Ophthalmic Society”•Throughwebsite:

http://www.bangaloreophthalmicsociety.org(kindlysendusanemailtobossummit18@gmail.comwithtransactiondetailsandbankname,sothatthe

transactioncanbetracked.Please mail the completed Registration Form

along with DD / Cheque to:dr Sheetal Ballal, OrganisingSecretary,

BangaloreWestLionsSuperspecialityEyeHospital,No5,LionsEyeHospitalRoad,OffJCRoad,

Bangalore560002

Documents

S S U MIT 18 O B Bossummit with a difference ITC Gardenia, Bangalore · Hospital / Institution: _____ Mailing Address: ... • Registration Fee includes Delegate Kit, Admission to