REGISTRATION FORM

Study Designs for Evaluation of Drugs acting on CNS in Animals

Saturday, 29 August 2009,
Department of Pharmacology, KMC, Mangalore

REGISTRATION FORM
Name: _______________________________________


Designation: ___________________________________


Institution: ____________________________________


Address: ______________________________________

__________________________________________________________________________________________
Mobile No: ____________________________________


E-mail: _______________________________________


Participation in the “Best Protocol Competition: Yes / No


Signature of the delegate
Registration Details:
Registration Fee: Rs. 200/-
(Includes breakfast, lunch, tea and workshop booklet)

The amount can be paid through a DD payable at Mangalore / multicity cheque favoring “Kasturba Medical College, Mangalore”

Last date for the registration: 20 August 2009
This form can be photocopied and used