12th International Double Stranded RNA Virus Symposium

12th International
Double Stranded RNA Virus Symposium
6-10 October, 2015, Goa, India
REGISTRATION&HOTELBOOKINGFORM
DelegateDetails
Title: ☐Dr☐Prof☐Mr☐Ms☐Mrs
FirstName:_________________________________LastName:_________________________________Gender:☐M☐F
Organiza on:______________________________________________________Posi on:______________________________
PostalAddress:__________________________________________________________________________________________
Suburb/City:_______________State(Province):_______________Postcode:________Country:_______________________
WorkPhone:_________________Mobile:_________________Email:_____________________________________________
ForInterna onalDelegatesOnly
PassportNumber:________________DateofIssue:______________________(dd/mm/yyyy)
ExpiryDate:_____________________(dd/mm/yyyy)PlaceofBirth:_____________________________________________
AccompanyingFamilyPersonDetails(Incaseofaddi onalnames,theformmaybephotocopied)
☐Dr☐Prof☐Mr☐Ms☐Mrs
GivenName:________________________________________FamilyName:_______________________________________
ForInterna onalAccompanyingFamilyPersonsOnly
PassportNumber:_______________DateofIssuing:________________(dd/mm/yyyy)
ExpiryDate:______________________(dd/mm/yyyy)PlaceofBirth:___________________________________________
Registra onFees(Please cktherelevantboxbelow)
Registra onType
BeforeAugust10,2015
Interna onalDelegate
☐ USD300
☐ USD415
Interna onalAccompanyingFamilyPerson
☐ USD150
☐ USD210
IndianDelegate
☐ INR9400
☐ INR11725
IndianAccompanyingFamilyPerson
☐ INR5000
☐ INR6000
DelegateRegistra onfeeIncludes:
Mee ngliterature&accesstoallScien ficSessions.
 Tea/coffeeandlunchonallsymposiumdaysattheSymposium
venue.
 Dinner at a specified loca on in the hotel on all days, except
October9th.AnoffsitesocialeveningisbeingarrangedonFriday,
October9th.Delegateswhodonotwishtopar cipateinthisevent
are requested to make their own dinner arrangements on this
date.
 Theregistra onfeeincludesallcurrentlyapplicabletaxes.Iftaxes
imposedbytheGovt.ofIndiachange,anaddi onalfeemaybe
charged.

August11,2015Onwards
AccompanyingFamilyPersonRegistra onfeeIncludes:
Tea/coffeeandlunchonallsymposiumdaysattheSymposium
venue.
 Dinnerat a specifiedloca on in the hotelon alldays, except
October 9th. An offsite social evening is being arranged on
Friday,October9th.Personswhodonotwishtopar cipatein
thiseventarerequestedtomaketheirowndinnerarrangements
onthisdate.
 The registra on fee includes all currently applicable taxes. If
taxesimposedbytheGovt.ofIndiachange,anaddi onalfee
maybecharged.

HotelAccommoda on(GoaMarrio Resort&Spa)
RoomType
Special Rate per Night (INR)
SingleRoom
☐ 12,700
Twinsharingroomwithsomeoneallo edbytheSecretariat
☐ 6350 per person
TwinsharingroomwithSharedwithpersoniden fiedbyyou
☐ 12,700 for two persons
Sharer Name:____________________________________________________________________________________________
Pleasespecifydietaryrequirement:☐Veg ☐Non-Veg ☐Allergiesifany,specify:_________________________________
TheSpecialRateincludes:
Buffetbreakfast
Allcurrentlyapplicabletaxes


Check-inDate:________________Check-outDate:_________________
Totalno.ofNights:_____________TotalAmount:__________________
PaymentOp ons
☐ DemandDra :(OnlyforIndianPar cipants)–PaymentscanbemadebyaDemandDra favouring
“KWConferencesPvtLtd”,payableatNewDelhiandsentthroughcouriertothebelowmen onedaddress:
(Event:dsRNA2015)KWConferencesPvt.Ltd.
A-56/12,DLFPhase-I,Gurgaon-122002,Haryana,India,Tel.:+911244636700/722
PleasewriteDelegateNameinBLOCKLETTERSatthebackoftheDemandDra .Anemailwillbesentuponreceiptofthe
registra onfee.
☐CreditCard:MasterCardorVISA(forOnlineRegistra ononly)
☐ BankTransfer:Kindlymen onyourName,ConferencenameandyourRegistra onIDnumberonthetransfertolocatethe
payment.Also,pleasesendustheremi anceadviceorreceipttotracethepaymentatregistra on@dsrna2015.org
NameofBank
: AxisBankLtd
AccountNumber : 357010200000578
AccountHolder : KWCONFERENCESPVT.LTD.
IFSCode
: UTIB0000357
SWIFTCode
: AXISINBB357
BankAddress
: B–81,DefenceColonyNewDelhi–110024India
BookingCancella onandRefundPolicy
Registra on:
1. Requestsforcancella onofregistra onreceivedinwri ngbytheconferencesecretariatatregistra ons@dsrna2015.orgwillberefunded
a ertheSymposiumatthefollowingrates:
-Onorbefore20August2015-Fullfeeminus25%cancella oncharges.
-A er20August2015:Norefundcanbemadealthoughanalternateregistrantcanbesubs tutedun lOctober1,2015.
2. Allrefundswillbemadewithin60daysa ertheSymposium.
ImportantNote:Dateofreceiptofcommunica onforcancella onwillbeusedforcalcula ngtheamountofrefund.Refundswillbecredited
onlytotheaccountfromwhereregistra onwasreceived.
HotelAccommoda on:
1. Reserva onofhotelroomsrequiresadvancepaymentforthetotaldura onofstay.
2. Requestsforcancella onsorchangesfromtheoriginalbookingmustbedirectedviaemailtohotels@dsrna2015.org.Pleasedonotcontact
thehoteldirectlyasthisbookingismadeataspecialrate.
3. Forcancella onsreceivedonorbefore20August,2015theen rebookingamountforaccommoda onwillberefunded,a erdeduc ng
banktransac oncharges,applicabletaxesandanadministra vefeeofINR500.
4. Forcancella onsreceiveda er20August,2015norefundswillbemade.Incaseofchangeindatesofarrivalanddeparturereceiveda er20
August,2015,therewillbenorefund.Addi onally,norefundswillbeapplicableincaseoflatecheck-inorearlycheck-out.
5. Allrefundswillbemadewithin60daysa ertheSymposium.
Iagreewiththeaboveterms.
Delegate’sSignature___________________________________Date:____________________
Please courier the filled in Registra on Form along with Payment to:
dsRNA2015
KWConferencesPvt.Ltd.,A-56/12,DLFPhase-I,Gurgaon-122002India
Ph:+911244636700/722Fax:+911244102075,Email:registra on@dsrna2015.org
PLEASENOTE:REGISTRATIONWILLBECONFIRMEDONRECEIPTOFPAYMENTONLY