Registration Form
Name  
Sex
Age
Designation
Hospital/Institution  
Address
City
State
Pin Code
Country
Phone
Fax
Email  
Demand Draft Details
I am enclosing a Bank Draft No. Name and Branch of the Bank for Rs drawn in favor of LAICO, payable at Madurai.
Registration Information
EARLY BIRD: The ‘Early Bird Registration’ deadline has been extended until 20th January, 2012 .
  • Delegates : Rs.1000/- per delegate
  • Students : Rs.600/- per student
ADVANCE: (21st January – 5th Mar 2012)
  • Delegates : Rs.1100/- per delegate
  • Students : Rs.700/- per student
SPOT/LATE REGISTRATION: (March 6th 2012 onwards)
  • Delegates : Rs.1300/- per delegate
  • Students : Rs.850/- per student



Cheque or Demand Draft should be sent to the following address:
Mr. Sanil Joseph
Organizing Secretary - PRISM 2012
LAICO- Aravind Eye Hospital
72, KurivikaranSalai, Gandhi Nagar ,
Madurai – 625 020
Email: prism2012@aravind.org
Mobile:+919894279089, +918144048673
Phone: 0452 –4356500