Foot conditions in leprosy at KOLKATA

PREMANANDA MEMORIAL LEPROSY HOSPITAL, 259/A, A. P. C ROAD, MANICKTALA, KOLKATA. 700006 WEST BENGAL,

DEPARTMENT OF PHYSIOTHERAPY & OCCUPATIONAL THERAPY

workshop ON

“FOOT CONDITIONS IN LEPROSY”

    DATE: 27^th and 28^th MARCH 2012

 

REGISTRATION FORM

Full Name:……………………………………………………………………………………

(In Capital Letters)

Institution:……………………………………………………………………………………

Designation…………………………………………...…………………………………….

Postal address:………………………………………..………………………………………….

……………………………………………………….……………………………………………

…………………………………………………………………………………………………….

Mobile No:…………………………………………....  Email address: ………………………….

Attached D.D No: ………………………………………………….dated ……..............................

In favor of …………………………………………………………………for Rs………………….

Registration fees (on or before 22/03/ 2012): Rs. 500.00 

 Spot Registration: Rs 700.00      

Accommodation/Day: Rs. 200.00

Last Date for registration: 22/03/2012

Note:

1. Accommodation will be on “first come first serve” basis.
2. The draft should be in favour of “PREMANANDA MEMORIAL LEPROSY HOSPITAL” payable at Kolkata.
3. Refreshment & Lunch will be arranged by the hospital. Outstation candidates have to arrange dinner themselves.

Please feel free to contact any of us if you have any difficulty:

            1. Mr. Mrinmoy Karmakar: 9331770539/mrinmoykarmakar1805@gmail.com

                2. Mr. Nidhu Mahato: 9477116681/ nidhumahato@gmail.com

            3. Ms. Naomi Simick: 9674520352/ naomisimick@gmail.com