REGISTRATION /ACCOMODATION INFORMATION

Dear All,
For the REGISTRATION & ACCOMODATION FORM send in a request email at peo.msb@gmail.com and we will email it within a day's time.

Alternatively you could SMS your email id at the mobile numbers mentioned on the introduction page with your name and college name.

Registration Fees is Rs 100 for each event.

All the team members have to register individually for the technical event for the entry to be considered.
Each student can submit a maximum of three abstract with the same or different team mates

For registration in more than two events the amount fixed is
Rs 300.
(eg.Rs 300 for three, four or in all five events)
You have to pay the amount via DEMAND DRAFT issued in the favour of "INDIAN PHARMACEUTICAL ASSOCIATION - MAHARASHTRA STATE BRANCH" to take part in the Rx TECHNICAL SYMPOSIUM ( irrespective of the number of event you intend to take part) upto 18th JANUARY 2011.

ABSTRACTS SUBMITTED AFTER MIDNIGHT OF 18th JANUARY 2011 WILL NOT BE ACCEPTED.

The students will be intimated about their selection for the events by 22nd January 2011.

Accommodation Update:

Participants who wish to avail the accomodation facility are requested mail us at peo@gmail.com

The details to be mailed include :

• Number of students
• Date of arrival
• Duration of stay

Note:
1. A decent hotel with all basic amenities will be made available for accommodation.
2. As your college is also invited for Rx Cultaral Festival you may extend your stay for the same which is on 29th and 30th January.
3. You will be informed of the charges of accomodation by 20 th January 2011.

REGISTRATION FORM:

Please copy the registration form given below in a word file and get a print out.

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INDIAN PHARMACEUTICAL ASSOCIATION STUDENTS’ FORUM

MAHARASHTRA STATE BRANCH

RX TECHNICAL SYMPOSIUM

JANUARY 28th 2011.

Venue: Bombay College of Pharmacy, Kalina, Santacruz (E), Mumbai 400098 .

REGISTRATION FORM

Name Mr. / Ms. ________________________________________________________________________

Course & Year of Studying:_________________________ Date of Birth:____________

Member of IPA(Y/N)_________other_________________________________________

University/College/Institution Name and complete address:________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

Residential Address: ______________________________________________________

_______________________________________________________________________

_______________________________________________________________________

City:______________ Postal Zip Code:_______________

Mobile:__________________ Telephone: (_______)_____________

Area Code

Email: ___________________________

Events wish to participate (please tick appropriate boxes)

Technical paper presentation

Technical poster presentation

Business Plan Presentation

Pharma quiz

Model Making

Payment Method:

Registration fees:

Rs 100 for one single event(upto 2 events)

Rs 300 for more than two events

Please remit payment by Demand draft payable to “Indian Pharmaceutical Association – Maharashtra State Branch” payable at “Mumbai”

D.D. Number:

Dated:______________________

Drawn on: (Name of the Bank and address)____________________________________ _______________________________________________________________________

_______________________________________________________________________

Rules:

• Every individual participant must send the completed application form to the below address.
• Registration fees includes only the registration cost for the Technical Event and excludes accommodation and other costs.
• Spot registrations are not accepted.
• Registrations are not accepted after 18th January 2011.
• In case of rejection of abstract or cancellation registration fees is non refundable.
• IPA-SF-MSB is not responsible for any personal damage or loss or damage to the properties of participants in any case.

Place: Date:

Signature:

• (Signature over here means that the student has accepted the terms and conditions mentioned on this form)

Please mail completed registration form to:

(courier, speed post, postal mail, etc)

Kind Attn- Mr. Mathew

IPA Office,

Bombay College of Pharmacy,

Kalina, Santacruz (E),

Mumbai 400098.

Phone: 022- 26671072

Fax: 022-26670744

For registration queries: peo.msb@gmail.com

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ACCOMMODATION REQUEST FORM:

Please copy the accommodation form given below in a word file and get a print of the same.

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INDIAN PHARMACEUTICAL ASSOCIATION STUDENTS’ FORUM

MAHARASHTRA STATE BRANCH

RX TECHNICAL SYMPOSIUM

JANUARY 28th 2011

Venue: Bombay College of Pharmacy, Kalina, Santacruz (E), Mumbai 400098

ACCOMODATION REQUEST FORM

Name Mr. / Ms. ______________________________________________________________________

Course & Year of Studying: _________________________ Date of Birth:___________

Member of IPA(Y/N) ________any other______________________________________

University/College/Institution and complete address: _____________________________

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

Residential Address: ______________________________________________________

_______________________________________________________________________

_______________________________________________________________________

City: _________________ Postal Zip Code: _________________

Mobile: ________________________ Telephone: (_______) _____________

Area Code

Email: ___________________________

Travel Details:

Date and Time of Arrival:

Date and Time of Departure:

Mode of travel:

No. of days you desire to stay (Not more than five):

Rules:

• Every individual participant must send the completed application form to the below address.
• Fees of accommodation should be paid to the accommodation in-charge by cash after your arrival and it would be distributed on first come first serve basis.
• Accommodation fees includes only the accommodation cost for the Event and excludes food.
• Accommodation request form will be accepted only if sent with Registration form.
• Accommodation request forms are not accepted after January 2010
• Fees of accommodation once paid will not be refundable under any circumstances.
• IPA-SF-MSB is not responsible for any personal damage or loss or damage to the properties of participants in any case.
• Accommodation charges will be posted on the blog on or before 20^th January 2011

Place: Date:

Signature:

• (Signature over here means that the student has accepted the terms and conditions mentioned on this form)

Please mail completed form to:

(courier, speed post, postal mail, etc)

Kind Attn- Mr. Mathew

IPA Office,

Bombay College of Pharmacy,

Kalina, Santacruz (E),

Mumbai 400098.

Phone: 022- 26671072

Fax: 022-26670744

For any queries: peo.msb@gmail.com

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