UPNCON 2009
24
th
& 25
th
October, 2009.
Hosted by Lucknow Nursing Home Association
Registration Form
* Fields are Required for Registration.
1. Name of Delegate 1
*
2. Name of Delegate 2
3. Name of Hospital
*
4. Address
*
5. E-mail
6. Mobile / Phone
7. Names of Hospital Staff participating in workshop on 24th October
7.1.
7.2.
7.3 Arriving on
7.4 By
7.5 Whether accommodation for 24th night is required
Yes
No
(If yes Please fill the accommodation form)
Details of payment
Please attach a draft favoring UPNCON 2009, payable at Lucknow.Registration Fee is Rs. 1000/- per Hospital for couple registration.For pre-conference workshop Rs 500/- per participant is to be paid in advance.Address for correspondence: UPNCON 2009, LHNA Blood Bank, B-72-A, Nirala Nagar (Near Charan Guest House), Lucknow – Ph. 0522 4070185, 4070285.