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Toxicology course (8th to 12th October).

REGISTRATION

XXVII Annual Conference of Society of Toxicology, India (STOX)

And

International Workshop on Toxicology

Towards Diplomate of American Board of Toxicology (DABT)

Registration Form (Please Type Or Print)

Name:………………………………………………………………………………………………………………...

Address:……………………………………………………………………………………………………………... …………………………………………(City)……………………………….(Pin)…………………………………(State)……………………………...............

Gender:Male   Female   

Telephone: [Off.]…..…………………….[Res.] …..……………………. [Cell] …..…………………………….

Fax: …..…………………….E-mail:…..…………………….…..…………………………………………………

Food Preference: VegetarianNon-Vegetarian     

Registration:STOX ConferenceToxicology CourseTotal

D.D. / Cheque:Rs……………….Rs……………….Rs……………….

Enclosed please find a Crossed Cheque / D.D. for Rs……….…………(Rs………………………….. …………………………………………………………………………………...Only) Bearing No………………. Dated……..……………..Drawn on…………..…………………………………..………………………..(Bank) payable at Bangalore in favor of “TREASURER, STOX-2007” and send to:

DR.K.JAYAKUMAR, Organizing Secretary, Department of Pharmacology & Toxicology Veterinary College,

Hebbal, Bangalore-560024, Karnataka State, INDIA.

Registration fee for STOX Conference:

Registration fee for Toxicology Course

Members of STOX /

Rs.1000

University Staff:

Rs.15,000

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