IInd INTERNATIONAL CONFERENCE OF PHYSICAL THERAPY & WORKSHOP

12-17 Dec 2013 A.I.I.M.S, New Delhi, INDIA

REGISTRATION FORM
Please Complete the form and send with Registration fee. Baban Mohankar, Organizing Secretary, Room No. 17, 6th Floor, Neuro Sciences Centre, AIIMS, New Delhi-29 Tel: +91-9868914547, 9968700569 E-mail: aiimsincpt@ymail.com , incptaiims2013@gmail.com

Personal Information (Please type or print clearly in CAPITAL LETTERS) *all fields marked with a star are mandatory.
* Delegate Student Invited speaker Committee member Government official

*First (Given) name:

Middle name:

*Last (Family) name:

*Name for badge & Certificate:

Passport number: (for Visa Purpose) ( If you require Visa support) *Organization/Institute/Hospital:

*Postal Address:

*Postal Code: *Tel: (country code-area code tel no.)

*City:

*Country:

*Mob.

*E-mail address:

*Program attending: (Please tick your choices) Dec 15 Tutorial/CME Dec 12, 13 Pre-workshop
No charges for tutorial/CME session.

Dec 14, 15 Conference Dec 16, 17 Post-workshop

Summary of payment
*Registration fee:
By 31st May (Super Early Bird) Student Delegates/Govt. Officials SAARC Countries International Delegates
*Payment

By 1st June- 30th Nov (Early Bird) 1800.00 2000.00 80 USD 120 USD

Spot 2200.00 2500.00 100 USD 150 USD

1200.00 1500.00 60 USD 90 USD

can be made by Multicity Cheque / Draft / Cash/ Money Transfer. Payment made by Cheque / Draft should be drawn in favour of INCPT AIIMS 2013, payable at New Delhi. Direct money transfers to the Bank Account no 32985348121 by using National SBI N000 1536 and International SBI NINBB545 Swift code. DD/cheque no. with bank and *Program (registration fees) Amount Payment mode branch details Conference Workshop Total
TOPIC
Inaugural pre-conference International Workshop on Physiotherapy Management in Spinal Cord Injuries International workshop on Kinesiotaping

Cash Draft Cheque

Resource Person
Dr. Lisa Harvey

Date
22th October 12th-13th December 12th-13th December 12th-13th Decenber 16th December 13th December 16th December

Course Fee
Rs. 1200/-

Venue
AIIMS

Manual Therapy and Taping Technique In Thoracic Rib Cage Dysfunction Hands On workshop on Dry Needling International workshop on Isokinetic:Basic Principle and Procedures In Clinical Practice Workshop On Research Methodology Radio-Diagnosis For Physiotherapist

Hands On Workshop Vestibular Rehabilitation Electro-Diagnosis in Physical Therapy(NCV & EMG)

International Workshop on Band, Tubes and its Physiotherapeutic Application Live Physiotherapy Management in ICU Workshop on Women Health : Antenatal and Postnatal Care

Abraham Joel Victor,Malaysia,Serving sports Physiotherapists in Malaysia Certified kinesiotaping Instructor From Australia Prof Uma Shankar Mohanty Founder Director of MTFI Diana Pinto Bill Galway, Clinical Educator USA Prof S.N.Dwivedi, Prof in Biostatistics, AIIMS DR.Jagnathan Prof.&Head,Deptt of Nmr,AIIMS Basic Anatomy& Physiology Dr. Sanjay Thulkar Additional Professor DR.Prakash Tayade Chief Radiologist NTPC(Spine & Limb) Dr.Sandeep Sharma,MBBS,MS ,ENT Dr.Preeti Madaan,BPT,CVRT DR.ACHAL SRIVASTAVA ADDITIONAL PROF ,Department Neurology, AIIMS Dr.Mamta Bhushan Singh,Addl Proff Department of Neurology,AIIMS Lee Huey Ying, Malaysia Rajeev Aggarwal Rithika Bhardwaj

Rs 3500/

AIIMS

Rs 1800/ Rs 2000/ Rs 1000/ Rs 800/ Rs 1500/

AIIMS AIIMS AIIMS AIIMS

AIIMS

16th- 17th December 17th December

Rs 1500/ Rs 1400/ AIIMS AIIMS

16-17 December 16 December 17 December

Rs 1500 Rs 1500 Rs 750

AIIMS AIIMS AIIMS

Signature