Registration Form LASA

REGISTRATION DETAILS
Full Name
Designation
Organization/University
LASA membership Number
Phone
Town/City		State
Fax No.		Country
Email		Address

CONFERENCE FEES (Please check appropriate box.)
	On or Before 30^th September 2017	After 30^th September 2017
LASA Member	Rs. 5000/-	Rs. 6000/-
Non Member (Government Organization)	Rs. 5500/-	Rs. 6500/-
Non Member (Corporate)	Rs. 6000/-	Rs. 7000/-
Student	Rs. 2500/-	Rs. 2500/-
Foreign Delegate	Rs. 7000/-	Rs. 8000/-

PRE CONFERENCE WORKSHOP (24 November 2017)
I want to attend Preconference workshop at CSIR-IGIB, Mathura Road, Delhi	Yes	No
	On or Before 30^th September 2017	After 30^th September 2017
Pre conference workshop Fees (Free for students only )	Rs. 5000/-	Rs. 6000/-

PAYMENT DETAILS
	Number / Transaction Code	Date	Bank Name
Demand Draft
NEFT / RTGS
Amount:

Bank details for NEFT/RTGS transfer:
Bank:	HDFC Bank Ltd	Account Number:	50200025697068
MICR Code:	110240243	IFSC Code	HDFC0002024
PAYMENT BENEFICIARY: Demand Drafts are to be payable to: ' LASA CONF 2017 '

For any payment related queries please send an email to :
Or Post To Treasurer – LASA conference 2017 on the following address;
Dr. Dinesh Kanwar Yadav, Veterinary Officer, Central Laboratory Animal Resources, Near Post Office , Jawaharlal Nehru University,
New Delhi-110067, Mobile: +91 9811259724

*Note: Registration charge does not include accommodation. Participants are requested to make their own arrangement for the accommodation.