| TRICO 2010 Online Registration |
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| Please complete all fields marked with *. |
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| Name |
* |
| Full Mailing Address |
* |
| City |
* |
| State/Province |
* |
| ZIP Code/PIN |
* |
| Country |
* |
| Phone (Hospital/Clinic) |
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Phone
(Residence) |
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| Phone (Cell/Mobile) |
* |
| E-mail |
* |
| Gender |
* |
| Institute/Hospital Name |
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Do You Require
Hotel Accommodation? |
Yes
No * |
| Sponsoring Company's Name |
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| Attended a Previous TRICO? |
Yes
No * |
| Registration Fee |
| Country |
Delegates |
Nurses & Technicians |
| India |
INR 5,000 # |
INR 5,000 # |
| Outside India |
USD $1,000 # |
USD $1,000 # |
Make your cheque/draft payable to
"Transradial Intervention Course: TRICO."
For payment from outside of India, click here to make an online payment with your credit card.
Note: Registration fee includes pick-up and drop-off from/at the airport, two nights hotel accommodation, transportation to and from the venue's site, all meals, our splendid TRICO "Gala Dinner," and a complimentary copy of "Patel's Atlas of Transradial Intervention: The Basics." |
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| Comments |
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