49TH IDA KERALA STATE DENTAL CONFERENCE

20,21,22 January 2017 | Hotel Windsor Castle, Kottayam | www.49ksdc.com

REGISTRATION FORM
Regn No: Del/RC

Title: Dr/Mr/Mrs Name:

Age: Sex: Ida Membership No: Ida Branch:

Address for Correspondence

with P.O:

District: State: Pin No: DCI Reg No:

Mobile No: TelNo: Email id:

No. of Accompanying Persons/

Kids above 8 yrs with Name & Age:

UPTO AFTER
REGISTRATION CATEGORY
NOVEMBER 15th NOVEMBER 15th
Reception Comm. member* Member Rs. 4000 Rs. 4500
Combo Offer@Rs.7000**** Non Member Rs. 6000 Rs. 6500
Member Rs. 1000 Rs. 1500
Delegate**
Non Member Rs. 2300 Rs. 2800
UG Student/Intern** Member Rs. 600 Rs. 700
(Combo Offer & Rs.1500*****) Non Member Rs. 800 Rs. 900
Accompanying Person*** Rs. 3000 Rs. 3500
Children 6yrs - 10 years Rs. 1500 Rs. 2000
Children above 10 years Rs. 3000 Rs. 3500
* Includes Registration kit, Inaugural dinner, Gala banquet , Two Lunches, Gift, Entry to Scientific sessions & Trade Exhibition.
** Includes Registration kit, Entry to Scientific sessions & Trade Fair. ** Letter from the Head of institution is mandatory.
***No certificate of participation. Only eligible for Inaugural dinner, Gala banquet , 2Lunches, Entry to Scientific sessions & Tradefair
****Includes RC Registration Previleges and Accommodation from Jan 20 Fri 12 noon to 22 Sunday 6pm , Breakfast on Sat & Sun&
an attractive gift for the 1st 50 combo registrations.
*****Includes Preconference Lecture, Lunch &Inugural Dinner 20th Jan,Entry to tradefair, Scientific lectures, Paper Presentation,
FREE IDA membership for 2017, Delegate Registration kit etc. (FOR PAYMENTS CHOOSE OPTION 1, OPTION 2 OR OPTION 3)
OPTION-2
OPTION-1 Pay by cash to the Conference account
Send the duly filled registration form with DD in favour Name of Bank: South Indian Bank
of 49th IDA KSDC payable @ Kottayam to Branch: Mallapally Branch
Ac Name: 49th IDA KSDC
Prof.Dr Eapen Thomas.,M.D.S Ac. No: 0314073000000308
Organising Secretary, 49th KSDC IFSC Code: SIBL0000314
ACE Dental Specialty Clinic, Holyfamily complex, Kanjikuzhy, *Enclose a copy of the payment slip with the
Muttambalam P.O, Kottayam-686004 , KERALA registration form and send an image of both to
Mobile: +917025148111 Ph: 0481-2573179 register.49ksdc@gmail.com & WhatsApp no 9447057199

OPTION-3
Register online at www.49ksdc.com (Please keep the payment details ready before online registration)