6th Annual Conference of Uttarakhand State Ophthalmological Society
October 2nd, 3rd & 4th 2009
ABSTRACT SUBMISSION FORM
Presenting Author ………………………………………………………………………………................................................
Mailing Address………………………………………………………………………………….................................................
………………………………………………………………..State……………….………..Pin…….……………………………………………
Tel.: Hospital/Clinic…………………………………………Residence………………………….………………………………………..
Mobile………………………………………………………...E-mail…………………………….………………………………………………
Name of Co-Authors………………………………………………………………..………………………………………………………….
Title of Presentation…………………………………………………………….……………………………………………………………..
Type of Presentation: Free Paper / Poster / Video Film Competitive / Non- Competitive
Subject Category…………………………..….…… Financial Interest Yes/No Signature…………..………………………
(1) Dr. M.C. Luthra Gold Medal - Best Paper Award for original work done and presented by author aged 45 years or less, open to members UKSOS only.
(2) Dr. Satanshu Mathur Award – best Video film open to all life members UKSOS & registered delegate.
Last Date of Submission of Abstract Form is 15th September 2009
Abstract: Not more then 100 words under heads of purpose, result and conclusion
Send Completed & Signed form to:
Dr. Gaurav Luthra, Chairman Scientific Committee, UASOS, Drishti Eye Center, 9B Ashley Hall, Dehradun 24001
For E-Mail Submission-UASOS@drishti.org
UTTARA EYECON 09- REGISTRATION FORM
6th Annual Conference of
Uttarakhand State Ophthalmological Society
October 2nd, 3rd & 4th 200
REGISTRATION FORM
NAME………………………………………………………………………………………………………………………………………………………………………………
ADDRESS………………………………………………………………………………………………………………………………………………………………………….
……………………………………………………………….. STATE…………………………………………….PIN………………………………………………………
TEL. (O)……………………………………. (R)……………………………MOBILE………………………………….E-Mail…………………….…………………
Accompanying Persons:
SPOUSE NAME………………………………………………………………………………………………………….……………
CHILDREN (ABOVE 12YRS) 1. ………………………...……………….… 2. ……………………………..……………….
CHILDREN (7 TO 12YRS) 1. ……….…………………...……………… 2. ……………………………..……………….
Complimentary Pre- conference Registration on 2nd Oct. Yes / N0
Hotel Accommodation required- Yes / No
For Hotel Accomodation Contact DR. SATANSHU MATHUR PH 9837120191
( One night advance deposit required)
Category Before 15th
Sept. 09 After 15th
Sept. & Spot
Delegate
(Member UKSOS) 1500/- 1800/-
Delegate
(NON-Member) 1800/- 2200/-
Resident 800/- 1000/-
Enclosed: a) Delegate registration fee Rs ________ b) Total Rs __
ENCLOSING THE TOTAL AMOUNT (IN WORDS)…………………………………………………………………………..……………………………………..
……………………………………………… BY CASH /DEMAND DRAFT NO …………………………………………... DATE………………………………….
DRAWN ON BANK ………………………………………………………….IN FAVOUR OF “UTTARAEYECON 2009”PAYABLE AT RUDRAPUR
TRAINS FROM IMPORTANT STATIONS TO KATHGODAM(26KM. FROM BHIMTAL)
From Train Name Train No Departure Time (Hrs) Arrival Time (hrs)
DELHI UTR.SAMPRK K EXP. 5035 16:00 22:40
DELHI RANIKHET EXP. 5013 22:45 6:05
LUCKNOW BAGH EXP. 3019 00:30 9:30
LUCKNOW NAINITAL EXP. 5308 20:55 6:10
DEHRADUN DDN KGM EXP. 4320 22:30 7:17
Mailing Address
DR ANURAG GARG (Organizing Secretary)
PRAKASH EYE HOSPITAL & LASER CENTER ,DOCTOR COLONY, CIVIL LINES, RUDRAPUR
PH: 05944-246946 FAX- 242394, MOB: 9837180286 E-Mail:uttaraeyecon2009@gmail .com
FOR OFFICE USE ONLY Receipt No. Regn. No.
Uttarakhand State Ophthalmological Society
October 2nd, 3rd & 4th 200
REGISTRATION FORM
NAME………………………………………………………………………………………………………………………………………………………………………………
ADDRESS………………………………………………………………………………………………………………………………………………………………………….
……………………………………………………………….. STATE…………………………………………….PIN………………………………………………………
TEL. (O)……………………………………. (R)……………………………MOBILE………………………………….E-Mail…………………….…………………
Accompanying Persons:
SPOUSE NAME………………………………………………………………………………………………………….……………
CHILDREN (ABOVE 12YRS) 1. ………………………...……………….… 2. ……………………………..……………….
CHILDREN (7 TO 12YRS) 1. ……….…………………...……………… 2. ……………………………..……………….
Complimentary Pre- conference Registration on 2nd Oct. Yes / N0
Hotel Accommodation required- Yes / No
For Hotel Accomodation Contact DR. SATANSHU MATHUR PH 9837120191
( One night advance deposit required)
Category Before 15th
Sept. 09 After 15th
Sept. & Spot
Delegate
(Member UKSOS) 1500/- 1800/-
Delegate
(NON-Member) 1800/- 2200/-
Resident 800/- 1000/-
Enclosed: a) Delegate registration fee Rs ________ b) Total Rs __
ENCLOSING THE TOTAL AMOUNT (IN WORDS)…………………………………………………………………………..……………………………………..
……………………………………………… BY CASH /DEMAND DRAFT NO …………………………………………... DATE………………………………….
DRAWN ON BANK ………………………………………………………….IN FAVOUR OF “UTTARAEYECON 2009”PAYABLE AT RUDRAPUR
TRAINS FROM IMPORTANT STATIONS TO KATHGODAM(26KM. FROM BHIMTAL)
From Train Name Train No Departure Time (Hrs) Arrival Time (hrs)
DELHI UTR.SAMPRK K EXP. 5035 16:00 22:40
DELHI RANIKHET EXP. 5013 22:45 6:05
LUCKNOW BAGH EXP. 3019 00:30 9:30
LUCKNOW NAINITAL EXP. 5308 20:55 6:10
DEHRADUN DDN KGM EXP. 4320 22:30 7:17
Mailing Address
DR ANURAG GARG (Organizing Secretary)
PRAKASH EYE HOSPITAL & LASER CENTER ,DOCTOR COLONY, CIVIL LINES, RUDRAPUR
PH: 05944-246946 FAX- 242394, MOB: 9837180286 E-Mail:uttaraeyecon2009@gmail .com
FOR OFFICE USE ONLY Receipt No. Regn. No.
UTTARA EYECON-09
The 6th annual State confennce of UKSOS will be held at Bhimtal from 2-4th October, 2009.
For details, please contact -
Dr. Anurag Garg,
Organizing Secretary Uttara Eyecon-09,
Prakash Eye Hospital & Laser Centre, Doctors Colony, RUDRAPUR
05944-242394
05944-246946
9837180286
dr_anuraaggarg@yahoo.com
For details, please contact -
Dr. Anurag Garg,
Organizing Secretary Uttara Eyecon-09,
Prakash Eye Hospital & Laser Centre, Doctors Colony, RUDRAPUR
05944-242394
05944-246946
9837180286
dr_anuraaggarg@yahoo.com
UKSOS EXECUTIVES
UTTARAKHAND STATE OPHTHALMOLOGICAL SOCIETY
PRESIDENT- Dr. R.P. Garg, M : 9411108906
HONY. GENERAL SECRETARY- Dr.Vinod Arora M : 9997171888, wavelasik@gmail.com
TREASURER - Dr. Amit Singh M: 9412347530, dramitsingh@hotmail.com
CHAIRMAN SCIENTIFIC COMMITTEE - Dr. Gaurav Luthra, M:9412059188, gaurav.luthra@drishti.org
Secreterial Office
Navjyoti Eye Hospital, Nehru Colony, Haridwar Raod, Dehradun -248001Ph : 0135-2672302, mob : 0999-7171 -888 email :wavelasik@gmail.com
Navjyoti Eye Hospital, Nehru Colony, Haridwar Raod, Dehradun -248001Ph : 0135-2672302, mob : 0999-7171 -888 email :wavelasik@gmail.com
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