<p> 7th INTERNATIONAL CONGRESS OF MEDICAL – COSMETIC ACUPUNCTURE Space for & 312 MERIDIAN EXERCISE Photograph</p><p>Hotel Ajanta Ambassador International 2nd to 5th November 2012</p><p>REGISTRATION FORM</p><p>Name</p><p>Sex Age Date of Birth </p><p>Address</p><p>City Pin Code State</p><p>Country STD. Code Ph-Home</p><p>Clinic Fax Mobile</p><p>Email</p><p>Qualifications</p><p>Accompanying Guests/ Spouses/ Assistant</p><p>I will read/ not read a paper Title Paper</p><p>Duration – 10 Minutes [ ] 20 Minutes [ ]</p><p>Including presentation of – 35 mm slides [ ] Video Tape [ ]</p><p>Overhead projector [ ] LCD [ ]</p><p>Signature Date: / /2012</p><p>1 CONGRESS REGISTRATION FEES FOR FOREIGN DELEGATES</p><p>1. Congress Registration Fees from 3rd and 4th November 2012 US $ 300/- [ Pre Congress & Post Congress are complimentary for foreign (Equivalent delegates ] in Indian currency) 2. Accompanying Non-Medical Wife/ Husband/ Assistant/ US $ 200/- Spouse (Equivalent in Indian currency) 3. Accommodation required Yes/No Single/ Double (If required send 2 days’ room tariff/ rent in advance) ______</p><p>Total Amount Paid 1] ______2] ______3] ______</p><p>Total US $ ______(Equivalent in Indian currency) Note: 1. You can pay the registration fees by Bank transfer or DD. For bank transfer please send to Dr. Lohiya, Chairman, Indian Academy of Acupuncture Science, State Bank of India [Account no. 11162581726], Industrial Estate Branch, Aurangabad, Maharashtra, India. OR Send DD addressed to Dr. Lohiya, Chairman, Indian Academy of Acupuncture Science, Jalna Road, N-2, CIDCO, Aurangabad-431 003, Maharashtra, India. 2. Please fill above form and send by Email – [email protected], [email protected] or Fax: 0091-240-2653822 3. Please send your article immediately to be printed in ACUS souvenir.</p><p>REGISTRATION FEES INCLUDES REGISTRATION FEES DOES NOT INCLUDE 1] Attending the Scientific sessions and group discussions 1] Accommodation, travel, excursion, 2] Copy of Souvenir – ACUS purchases and other expenses. 3] A kit with gift. 4] Two times tea with biscuits from 2nd to 5th November. 5] Lunch from 2nd to 5th November Dinner on 3rd November 6] Congress Attendance Certificates to delegates (2,3 & 6 Not for Guest/ Spouses/ Assistant)</p><p>2 CONGRESS REGISTRATION FEES FOR INDIAN DELEGATES before 15th October 2012 (Late fees of Rs. 200/- will be additionally charged, after 15th October, 2012) Note : The Congress is being held in a 5 Star Hotel hence Seats are limited. Delegates will be registered on first come-first serve basis.</p><p>1) Congress Registration Fees for 3rd and 4th November a) Acupuncturists / Doctors / Beauticians Rs. 2590/-</p><p> b) For Membership Certificate holders of Indian Academy of Rs. 2490/- Acupuncture Science [Attach Xerox copy of membership certificate]</p><p>2) a) Pre-Congress Course fees (2nd November) Rs. 1990/-</p><p> b) Post Congress Course fees (5th November) Rs. 1990/-</p><p>3) Concessional Fee for Main Congress plus Pre & Post Congress Rs. 5990/- together (2nd to 5th Nov.) 4) Accompanying Non-Medical Wife/ Husband/ Assistant/ Guest Rs. 1990/-</p><p>5) Cultural program with Dinner ( 3rd Nov.12 ) Rs. 600/- Amount Paid 1] ______2] ______3] ______4] ______5] ______Total Rs. ______Note: 1. Please send DD addressed to Dr. Lohiya, Chairman, Indian Academy of Acupuncture Science, Jalna Road, N-2, CIDCO, Aurangabad-431003, Maharashtra, India. Attach D.D. Slip to the registration form. 2. Please fill above form and send by Email – [email protected], [email protected] or Fax: 0091-240-2653822 3. Please send your article alongwith 2 Passport photographs immediately (before 15th August) to be printed in ACUS – the conference magazine. 4. If you wish to publish your Advertisement in the ACUS Magazine or keep a Stall please send e-mail to [email protected] for the details.</p><p>REGISTRATION FEES INCLUDES REGISTRATION FEES DOES NOT 1] Attending the Scientific sessions and INCLUDE group discussions on 3rd and 4th Nov. 2] Copy of Souvenir – ACUS 1] Accommodation, travel, excursion, 3] A kit with gift. purchases and other expenses. 4] Two times tea with biscuits on 3rd and 4th 2] Pre & Post Congress Courses. Nov. 5] Lunch on 3rd and 4th November PRE CONGRESS/ POST CONGRESS 6] Congress Attendance Certificate to the INCLUDES Delegates Guest/ Spouses/ Assistant - Eligible for 1] Folder only 4 & 5. They can also attend the 2] Lunch Opening Ceremony. 3] Two time tea with biscuits. Awards for Senior Acupuncturists -</p><p>3 Reputed Senior Acupuncturists who register for the Main as well as Pre & Post Congresses will be honoured with a Special Award, during the Conference. ______</p><p>4</p>