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Mr.

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Prof.

IORITIES IN POS
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5th APCPN

PEDICON 2016
Hyderabad, Telangana State, India

Receipt No. : .................................................

*IAP Membership No. : ...................................................

Dr.

PR

15th APCP

Thursday 21st Jan 2016 to Sunday 24th Jan 2016

Hyderabad International Convention Centre (HICC)
Hyderabad, Telangana State, India
REGISTRATION FORM
Please fill the form in CAPITAL letters only
*Title:

TH

15th Asia Pacific Congress of Pediatrics (APCP) &

53rd Annual Conference of
Indian Academy of Pediatrics (PEDICON) &
5th Asia Pacific Congress of Pediatric Nursing (APCPN)

(For Office Use)

Ms. (Please tick as appropriate)

*Name: .......................................................................................................................................................................................................................................................................
Date of Birth: ................................................ Age.: .......................... Gender:

Male

Female / Nationality: .............................................................................

Institute: ..................................................................................................................................... Designation : ......................................................................................................

Address: ......................................................................................................................................................................................................................................................................
*City: .................................................................... Pin: ....................................... State: ................................................................... Country: ......................................................
Telephone: (..........)......................................................................................................... *Mobile: ..........................................................................................................................
*Email: ........................................................................................................................................................................................................................................................................
Accompanying Person(s) Details: (Children above 5 Years)
1.

Name: .................................................................................................................................................. Age: ................................................

2.

Name: .................................................................................................................................................. Age: ................................................

3.

Name: .................................................................................................................................................. Age: ................................................

4.

Name: .................................................................................................................................................. Age: ................................................

Workshop Preferences:
Indian Delegate For 2 Days Workshop
Please give your 3 workshop preference mentioning workshop Codes:
Code: 1.
Code: 2.
CME Preference:

Yes

Indian Delegate For 1 Days Workshop

Foreign Delegate Workshop

Code: 3.

No

Meal Preference:
Veg.
Non-Veg.
Jain (please tick as appropriate)
*Mandatory fields.
*Senior Citizens age proof to be submitted. *PG to submit bonafide certificate from the HOD
Registration Fee Includes:
Admission to all Scientific Sessions, Trade Exhibition and Inaugural Ceremony.
CME registration.
Inaugural Dinner, Gala Dinner & Lunch on all days.
Conference Kit (For spot Registration subject to availability)
.
Registration
Guidelines:

Conference registration is mandatory to attend workshop & CME. Registration is mandatory for all.
Accompanying persons & children will not be allowed to the scientific sessions.
Children 5 years & above of age have to be registered as accompanying person.
Children below 5 years of age have to be registered (free of charges) for logistic and security reasons.
Organizing committee is not liable in any form in case of changes in dates due to unforeseen reasons.
Cancellation and refunds as per the Terms and Conditions.
Please produce your registration number / confirmation letter / payment receipt at the registration counter.
Please ensure to wear the conference badge at the venue.
Delegate kit will be different for Nurses

Total Amount : ............................................... (In Words): .............................................................................................................................................................................

I AM PAYING THE ABOVE AMOUNT BY FOLLOWING MODE
1) Wire Transfer
Account Name: APCP PEDICON 2016
Account Number: 62395231265

Address: State Bank Hyderabad, Gunfoundry branch, Hyderabad,Telangana State

IFSC/RTGS Code : SBHY0020066

Transaction Ref. No: ................................................................................................................. Dated: .................................................................................................................

2) Demand draft
Demand draft in favor of APCP PEDICON 2016 payable at Hyderabad
DD No.: ....................................................................................................................................... Drawn on: ........................................................................................................
Branch: .......................................................................................................................................... Dated: ...............................................................................................................
Date: .............................................
Signature: .....................................................

Conference Secretariat :TEAM APCP PEDICON 2016, Hyderabad, 3rd Floor, 6-1-57,Nasir Arcade, Saifabad, Hyderabad-500004,Telangana, India.
Email - secretariat@apcppedicon2016.in, Contact no - +91 9701227243, Website: - www.apcppedicon2016.in
Dr. N. Ravi Kumar
C/o Niloufer Hospital for children & Women,
Red Hills, Hyderabad 500004, Telangana, India
Dr. Ajoy Kumar
C/o Akshay Memorial Mother & Child Clinic 1-18, Divya Shakti Complex,
Greenlands Ameerpet Hyderabad - 500016, Telangana, India

Official Conference Manager

Mr. Chander Mohan Thakur Mr. Amit Katoch
Mob. No. +91 9818374745
Mob. No. +91 9899584678
Email: secretariat@apcppedicon2016.in

IORITIES IN POS
TDG

AL

PR

LD

C HI LD

W OR

HE

TH

15th Asia Pacific Congress of Pediatrics (APCP)

53rd Annual Conference of
Indian Academy of Pediatrics (PEDICON)
5th Asia Pacific Congress of Pediatric Nursing (APCPN)

15th APCP

5th APCPN

PEDICON 2016

Thursday 21st Jan 2016 to Sunday 24th Jan 2016

Hyderabad International Convention Centre (HICC)
Hyderabad, Telangana State, India

Hyderabad, Telangana State, India

REGISTRATION FEE
NATIONAL DELEGATES
REGISTRATION FEE IN INDIAN RUPEES (INR)
1st April 2015- 1st June 2015 - 1st Sep 2015 1st Dec 2015
31st May 2015 31st August 2015 30th Nov 2015 onwards / On Spot

Category (Please Tick)

IAP Member

10,000

15,000

20,000

25,000

Accompanying delegate of IAP member - 5 yrs & above (Refer Tariff)

12,000

17,000

22,000

30,000

Non IAP member

19,000

22,500

26,500

32,000

Accompanying delegate of Non IAP member - 5 yrs & above (Refer Tariff)

20,000

23,500

27,500

32,000

Post Graduate*

10,000

15,000

20,000

25,000

Accompanying delegate of PG - 5 yrs & above (Refer Tariff)

12,500

16,000

20,000

25,000

Indian Nurses

4,000

4,000

4,500

4,500

Indian Student Nurses

3,000

3,000

4,000

4,000

Trade/Corporate delegate

20,000

25,000

30,000

35,000

NIL

NIL

Sr. Citizen (above 70 Yrs. and for IAP members only)

Closed

No Spot

*Sr. Citizen Registration Closed by 31th August 2015.

*Workshop Fee
(Refer Tariff)

: For Indian Delegates 2000 (INR) for2 Days Workshop (Please Tick)
: For Indian Delegates 1500 (INR ) for 1 Day Workshop (Please Tick)

INTERNATIONAL DELEGATES
REGISTRATION FEE (USD - EQUIVALENT - INR)
CONVERSION RATE IS 1 USD = INR 65
Category (Please Tick)

1st Oct 2015 - 30th

Nov 2015

Currency
SAPA Delegate / SAARC Delegate

USD
325

1st Dec 2015 - 31st Dec

2015

INR
21,125
19,500

USD
350

1st Jan 2016

onwards/On Spot
USD
425

325

INR
22,750
21,125

350
325

22,750
21,125

425
400

300

19,500

400

27,625
26,000
26,000
22,750

Accompanying delegate of SAPA / SAARC - 5 yrs & above (Refer Tariff)

300

APPA Delegate
Accompanying Delegate APPA - 5 yrs & above (Refer Tariff)

325
300

Post Graduate, Fellows & Nurses SAARC/APPA/SAPA/APNA

Accompanying delegate of Post Graduate, Fellows & Nurses
SAARC/APPA/SAPA/APNA - 5 yrs & above (Refer Tariff)

200

21,125
19,500
13,000

175

11,375

250

16,250

350

Foreign delegate
Accompanying delegate of Foreign - 5yrs and above (Refer Tariff)

600
550

39,000

700
650

45,500

800

52,000

35,750

42,250

750

48,750

*Workshop Fee : For International Delegates

100 (USD) /

400

INR
27,625
26,000

6500 INR for Per Day Workshop (Please Tick)

(Refer Tariff)

REFUND POLICY ON CANCELLATIONS

Early bird

No refund

End of early bird 31st May 2015

50%

1st June 2015 31st Aug 2015

25%

From September 2015 onwards

NIL / No refund

All refunds will be made after the Conference

APCP PEDICON 2016 will process the refund amount as per cancellation policy (after deduction of bank charges) and will be credited back to same account
through which payment was made. Refunds will be processed within 30 days after completion of the conference.

Date: .............................................

Signature: ...................................................

Conference Secretariat :TEAM APCP PEDICON 2016, Hyderabad, 3rd Floor, 6-1-57,Nasir Arcade, Saifabad, Hyderabad-500004,Telangana, India.
Email - secretariat@apcppedicon2016.in, Contact no - +91 9701227243, Website: - www.apcppedicon2016.in
Dr. N. Ravi Kumar
C/o Niloufer Hospital for children & Women,
Red Hills, Hyderabad 500004, Telangana, India
Dr. Ajoy Kumar
C/o Akshay Memorial Mother & Child Clinic 1-18, Divya Shakti Complex,
Greenlands Ameerpet Hyderabad - 500016, Telangana, India

Official Conference Manager

Mr. Chander Mohan Thakur Mr. Amit Katoch
Mob. No. +91 9818374745
Mob. No. +91 9899584678
Email: secretariat@apcppedicon2016.in