VENUE: Le Meridien Hotel,BANGALORE.

GERIATRIC ORTHOPEDIC SOCIETY OF INDIA
INTERNATIONAL CONFERENCE OF GERIATRIC ORTHOPEDIC SOCIETY OF INDIA - GOSICON-2015
9TH TO 11TH October 2015, Bangalore, Karnataka, India

Conference Registration Details
Early Bird: Upto January 31st 2015
For registration details: Please click on the link Registration 2015
PAYMENT DETAILS
Fee Payable: Conference and Banquet
Total Amount: …………………………..........................
Mode of Payment: DD / Online transfer
Payments to be made in the form of DD to be drawn in favor of “GOSICON” Payable at Bangalore.
Direct NEFT - Transfers may also be made to the following account:
Account Name: GOSICON
Bank: Andhra Bank
Branch: Bilekahalli, Bannerghatta Road
Account No: 119611100002838
IFSC Code: ANDB 000 1196
Registration Includes
• Conference Kit
• Scientific materials
• Breakfast on both the days
• Lunch on both the days
• Banquet
For Hotels Bookings and / Travel assistance Contact:
Dr. Srinivas Reddy
Contact Details: +91 9845334405
Email: bn.roshan@gmail.com
REGISTRATION FORM
INTERNATIONAL CONFERENCE OF GERIATRIC ORTHOPEDIC SOCIETY OF INDIA - GOSICON-2015
Please complete all fields using BLOCK LETTERS ONLY.
Incomplete forms may not be processed.
GOS Membership No: ……………………
Name: …………………………………………………........................................................
Age : ……………………………
DOB:..............................................................
Sex : …………………
Professional Degrees: MS / D’Ortho / DNB (Ortho) / Others
Designation:
Field of Specialization:
…………………………................................................................
Institute:
…………………………………...........................................................................
PG / Consultant: …………………………………………….
Postal Address:
……………………………………………………………………………………………..........…………………………………………………………………………………………
Contact Details:
• Mobile No / Phone / Fax: ……………………………………..................................
• E-mail: ……………………………………………...................................................
Please mail the filled forms to:
Dr John Ebnezar
Founder President
Parimala Health Care Services ® (An ISO 9001:2008 Hospital)
Bilekahalli, Bannerghatta Road,
Bangalore – 560076, Karnataka, India.
Contact Details: Mobile: +91 9986015128
Phone / Fax: +91 80 26581231
Email: johnebnezar@gmail.com
pshospital@drjohnebnezar.com
Website: www.drjohnebnezar.com

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