Office of Research - PAHRT
USF-Health - India Program in Adolescent HIV/AIDS Research Training



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TRAI web form registration.


Name:

Company or Afilliation:

  • Address:

  • City: State:

  • Zip or Postal Code: Country:

    Telephone: Email:

     

    Conference

    Participation (Check all that apply)

    Invite Speaker

    Poster Presenter

    Attendee

    Student

    Post-Doctoral Trainee

     

    Accommodation

    I will be staying the Conference Hotel. Contact Hotel directly for booking and ask for the Conference rat.

    Vivanta by Taj - Panaji, Goa
    Off D. B. Bandodkar Road, Panaji, Goa 403001
    Tel No.: 011-91-9822583210
    Email: vivanta.panaji@tajhotels.com, www.tajhotels.com

     

       

       

    Registration Fees

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    Attendee

    		 Rs 7000  (USD 140)

    Student

    Rs 4000 (USD 80)

    Post-Doc Trainee

    Rs 3000 (USD 80)

    There is no registration fee for Invited Speakers, but timely registration required.
    Make Demand Draft/Money Order payable to: Community Resource Foundation.
    Under memo, write: TRAI GOA conference
                      
    Send Demand Draft/Money Order to:

    TRAI-Goa
    C/o. Community Resource Foundation
     Flat No. B-1, 2nd Floor, R.A. Apartments, Madel,
     Margao, Goa.  Tel:011-91-9822583210

    Please mail, email or fax the completed form to Alberto Aguilera, University of South Florida, 12901 Bruce B. Downs Blvd., MDC 19, Tampa, FL 33617, aaguiler@health.usf.edu, 813-974-8575 (fax). Please Note: Requests for Refunds must be received in writing by September,01,2010. No refunds will be granted after this date. A Rs2500 ($50) processing fee will be levied on all refunds granted.

    Thank you for your registration.


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