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Workshop on “In vivo Preclinical Imaging and Drug Discovery” Advanced Center for Treatment, Research and Education in Cancer (ACTREC) 7 – 9 September 2016 A. REGISTRATION DEAILS: Prof./Dr./Mr./Ms. __________________________________________________________________________________ Designation & Organization: __________________________________________________________________________________ Address: __________________________________________________________________________________ Town/City: ______________________ State: ________________________________________________ Pin / Zip Code: ____________________ Country: _____________________________________________ Tel: ____________________ Fax: ___________________ Email:_________________________________ B. Details of Registration Fees: a) Rs. 3000/- (students) b) Rs. 5000/- (Faculty / Scientists Govt Organizations) c) Rs. 10,000/- (Corporate) (Demand Draft / Cheque in favor of “ Director ACTREC”) C. PAYMENT: *A sum of Rupees _______________ Rs. (in words) ___________________________________________ by DD/Cheque. ________________dtd ___________ drawn on ________________________________ D. Demand Draft / Cheque and registration form to be sent on the following address: Dr. Pradip Chaudhari, Advanced Centre for Treatment, Research & Educa:on in Cancer (ACTREC), TATA Memorial Centre, Sector – 22, Kharghar, Navi Mumbai – 410210 Date:____________________ Signature:________________________ Accommodations near Workshop venue, ACTREC, Navi Mumbai Participants are requested to contact the hotel to make their own reservations 1) Three Star, Kharghar, Navi Mumbai 3) YUVA Centre Mr. Mahindra Thakur Mob: 9320129093 http://www.hotelthreestar.com Distance from ACTREC:-4.5 kms Plot No. 23, Sector 7, Kharghar, Navi Mumbai Tel: 022-27740990 / 70 / 80 Email: [email protected] Distance from ACTREC:-4.1 kms 2) Royal Tulip, Kharghar, Navi Mumbai 4) RETREAT GUEST HOUSE (ACTREC) Mr. Parag Dalal : 7506164547 http://www.royaltulip-navimumbai.com/en Distance from ACTREC:-4.7 kms Mr.Dinesh Tel:- 022-27405000 Mob: 09757455178