REGISTRATION FORM

IACI – 2017 Chennai
Mid Term CME
On 6th & 7th May 2017

(for online payment)

Registration Fee - Early Bird Offer till March 31st 2017

  Upto March 31st After March 31st Spot registration
IACI Members 2500 3000 3500
PG Students*** 2000 2500 3000
Non Members (Including IACI Membership) 3500 4000 4500

Account details for online payment
Account Name: INDIAN ASSOCIATION OF CARDIAC IMAGING
A/c No.: 912020060730871
IFSC Code: UTIB0000061
Bank Name: AXIS BANK LIMITED, DHIRAJ BAUG, LBS MARG, THANE (W) 400602

Mailing address for Registration:
Demand Draft in favour of “INDIAN ASSOCIATION OF CARDIAC IMAGING”
Mrs.Trupti Palkar
Chief Administrator, IACI
Head Office IACI:
Infinity Medical Centre, Citi Tower
Ground Floor, Next to MGM Hospital, Parel(East), Mumbai-400 012.
Tele.: 9833347481

For Enquiries:
Email: iacimidterm2017@gmail.com
Dr.S.Babu Peter
Organising Secretary, Mid Term IACI, Chennai.
Barnard Institute of Radiology, Tower block I MMC & RGGGH
Chennai - 600003

Dr.Elavazhagan - 9787028105
Dr.Harish - 9629978199
Dr.Sathiya - 9677990099
Mrs.Trupti Palkar - 9833347481

Website: www.iaciind.org, www.barnard.in
*** PG Student to send letter from their respective department to confirm the same.