103rd NHB Meet - Erode
REGISTRATION FORM
Date : 16.11.2014
Venue : Hotel AmudhaBhavan, Sampath Nagar, Erode
Name
:
TNMC No.
:
Designation
:
Hospital’s Name
:
Address
:
Mobile Number
:
E-mail ID
:
Amount
: Rs.600/- Mode of Payment : Cash/Cheque/DD
(In favour of : The Secretary IMA NHB Payable at Karaikudi.)
Payment Details
:
Are you IMA member [ Y es / No ]
Are you NHB member [ Yes / No ]
*(E-mail Id / Mobile No. / TNMC No. Mandatory)
Signature
Filled form to be sent to the following address.
Dr. V. Madhan Kumar
Secretary IMA Erode
MNP Nursing Home
650, Kunnathur Road
Perundurai - 638052
Mobile : 9443229321
Email id : [email protected]
Dr. B. Sridhar NHB State Secretary
Suba Savukya Hospital
Soodamanipuram, Karaikudi - 630003
Phone : 04565-226427,
Mobile : 94433 26427, 75983 26427
Email id : [email protected],
website : www.imanhb.org

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