Theory and Practice of Epidemiology and Biostatistics 2019

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Registration form

Name of Participant *

Designation

Name of the Institution

Do you have a Medical Council Registration number ? *

Yes

Required

If yes, please fill in the Medical Council Registration number and respective medical council below (eg 76890, Karnataka)

Contact Address

Telephone number *

E-mail ID *

Accommodation required

Yes

Clear selection

If yes, please tick choice

Within Campus - (non-A/c) Single Rs 750/Day

Within Campus - (non-A/c) Double Rs 1120/Day+ Tax/Day

Within Campus - (A/c) Single Rs 1680+ Tax/Day

Within Campus - (A/c) Double Rs 2240+ Tax/Day

Outside Campus - (A/c) Approx Rs 3000/day

Clear selection

Agreeable to sharing room

Yes

Clear selection

Food preference (Participants who wish to bring own lunch during the course can pay Rs 2000/- less towards the fee)

Yes

Clear selection

If yes

Veg

Non-Veg

Clear selection

Two main expectations from the workshop

Will you be attending 1-day demography course?

Yes

Clear selection

Transaction ID of bank transfer made or DD no

Important notes on registration

1. A separate registration form needs to be filled for each participant
2. Course fees
Before 12th June: Rs.8000/-(For Students) & 12000/- for Faculty. [After 12th June: Rs 12,000/- (for students) & Rs
17,000/- (for faculty) (plus 18% GST applicable on all fees)
2. Participants wishing to attend the 1-day demography course need to pay additional Rs 1000/- towards registration fee
3. Participants who wish to bring own lunch during the course can pay Rs 2000/- less towards the fee
4. For further clarification kindly contact Jeeva/Kavya, Telephone: 080-49467000 Ext-7030/7050

Contact for further enquiry

Dr Prem K. Mony, M.D.
Course Director
Head, Division of Epidemiology & Population Health
St. John’s Research Institute
Bangalore – 560034

Dr Tinku Thomas, PhD
Course Coordinator
Head, Biostatistics Unit
St. John’s Research Institute
Bangalore–560034

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms