the tnai tamilnadu - xxiv state tnai biennial...
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THE TNAI TAMILNADU STATE BRANCH
XXIV TNAI BIENNIAL CONFERENCE AT
OMAYAL ACHI COLLEGE OF NURSING
NO. 45, AMBATTUR ROAD, PUZHAL, CHENNAI – 66
TEL: 26591617, 26591618, Fax: 26591616
Theme: Quality Clinical Practice: Nurses’ Concern
REGISTRATION FORM
Name : Mr. /Ms. _____________________________________
Qualification & Designation : _____________________________________________
Institution with Address : _____________________________________________
TNAI Number : _____________________________________________
Hostel Accommodation Required: Yes / No; If Yes
Presenting Paper/Poster: Yes / No; If yes, Abstract sent: Yes / No
Remittance Details
Registration fees : _________________
Scientific Presentation Fees : __________________
Food & Hostel Accommodation: Rs.350 x days
Total Amount: _________ DD No: ____________ dated: ________
Drawee Bank___________ No. of Participants: __________
Contact No.* : Office No._____________ Mobile No. __________________
Email * : ______________________ Fax No. _____________________
Signature with Date :
Note: * Mandatory- for further correspondence
Xerox of registration forms can be used.
Date & Time of Arrival: _________________________________
Date & Time of Departure: ________________________________
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