BARIME - 2017BARIME - 2017

st1 National Post graduate CME on

Bariatric Surgery- 1-2 December, 2017

Name:……………………………………………………………………………...

Address:……………………………………………………………………………

Institution/Hospital:………………………………………………………………..

City……………………………………………………….Pin…………………….

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Mobile…………...............Office……………….......Residence……….................

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Payment Details:

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Draft No……………………………Online Transaction Details……………….....

Date……………………………Signature………………………………………...

For official use:

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Registration Form: BARIME 2017

Bank details for paymentName- Foundation for Obesity Research and Metabolic SurgeryBank- STATE BANK OF INDIA Branch name- AIIMS, Ansari NagarAccount no - 36090144621IFSC Code - SBIN0001536

Registrations Under/Post Graduate Others

Before 15 Nov 17 Rs 2000/- Rs 3000/-

After 15 Nov 17 Rs 3000/- Rs 4000/-

CME SecretariatthRoom No. 5034, 5 Floor, Teaching Block,

Ansari Nagar, AIIMS, New Delhi – 110029 Ph. No. – 011-26594905, 011-26588430E-mail : forms.aiims@gmail.com

Organizing SecretaryMs. Richa Jaiswal

Target audience- Surgery residents, medical students, nutritionists Limited number of delegates upto 150 No on spot registration

CME Co-ordinatorMs. Rachana ChoudharyPh:. 011-26594905/26588430

st nd*The above package includes- Registration fees, kit, lunches 1 & 2 & stbanquet dinner on 1 December, 2017