International conference on Aesthetic
and Anti Aging
20th-22nd April 2018, New Delhi
REGISTRATION FORM
Personal Details (Please use BLOCK LETTERS)
Title (Professor / Dr): ______
Surname Middle Name First Name
Age: ______Sex: M F VEGNON-VEG
Mailing Address ______
City:______State: ______
Pin Code: ______Country: ______
Telephone: Residence: ______Clinic: ______Mobile: ______Fax: ______
Email: ______/______
Visitor Type
Delegate / Residents / Foreigner:INR / USD______
Accompanying Person:INR / USD______
Workshop fees: INR / USD______
Total:INR / USD ______
* Inclusive of GST
Please make Payments in favor of “EstheticxpressLLP" and should be posted to Event Manager:
Mode of Payment: CashCheque Draft Bank Transfer
Cheque/Draft No.: ______Drawn on: ______Bank: ______
Branch: ______Dated: ______Amount: ______(INR)
Signature: ______Place: ______
REGISTRATION FEE
Visitor Type / Till 15th Nov’17 / Till 15th Mar’18 / On SpotFor Dermatologists and Plastic Surgeons
(as Delegate) / INR 8,000 / INR 9,000 / INR12,000
For Residents / INR 5,500 / INR 7,500 / INR 9,000
For Foreign Delegates / USD 240 / USD 260 / USD 295
For Accompanying Persons
(not allowed in Scientific Sessions) / INR 6,000 / INR 7000 / INR 8000
(CHOOSE YOUR WORKSHOP/MASTERCLASS)
19th April 2018
( ) Live surgery workshop on hair transplant 0900- 1600 hrs (observation) (20 seats on first come first basis )- INR12,000
20th April 2018
( ) Workshop on Chemical peels 0900-1300 hrs / INR 4,000 / ( ) Workshop on Fillers 1400-1700 hrs / INR 6,000
( ) Master class on Blepharoplasty 0900-1300 hrs / INR 4,000 / ( ) Master class on social media marketing 1400-1700 hrs / INR 4,000
21st April 2018
( ) Master class on how expert doctors practice aesthetic medicine 0900-1300 hrs / INR 4,000 / ( ) Workshop Neurotoxins basic indications 1400-1700 hrs / INR 6,000
( ) Master class on Fat grafting 0900-1300 hrs / INR 4,000 / ( ) Master class on Acne scars 1400-1700 hrs / INR 4,000
FREEComplimentary workshop on common aesthetic dermatology procedures for PG residents
on 21st April 2018 from 0900 hrs – 1400 hrs- only 50 seats first come first basis (copy of PG Resident Identity card required )
22nd April 2018
( ) Hands on Workshop on Lasers (0900-1400 hrs) / INR 6,000 / ( ) Hands on workshop on PRP (0900-1300 hrs) / INR 6,000
( ) Hands on Workshop on Hair Transplant on Model (0900-1300 hrs) / INR 6,000
* Inclusive of GST
Included in Registration fee
- Conference Kit
- Lunch on 20th April and 21st April
- Networking dinner on 20th April
Detail of Bank Transfer
Account Name:Estheticxpress LLPAccount No.:051463300000903
Bank:YES Bank Address: East of Kailash Branch, New Delhi - 110065
IFSC Code:YESB0000514
- Kindly send the copy of bank slip along with registration form if payment made through bank transfer.
- Credit Card transaction details to be attach if registered online.
Registration Guidelines / Refund Policy
- Conference registration is mandatory for registration in workshop
- Accompanying persons will not be allowed in scientific sessions
- Registration is mandatory to submit abstracts / - Cancellation received on or before 15th March: 50% refund
- Cancellation received after 15th March: No refund
- All refunds will be processed 30 days after the Conference
- Please Note: Telephonic cancellation will not be entertained