12 th Asian Oceanian Congress of Neurology
&
16 th Annual Conference of the Indian Academy of Neurology
(AOCN-IANCON 2008)

HOTEL BOOKING FORM

Accommodation possible via www.conferenceindia.org
Or send it to:

22-26th October 2008,

Hotel Ashok
New Delhi
India

AOCN IANCON 2008
Conference Manager
Neumech Events
51, Mandakini Enclave
Greater Kailash-II
New Delhi-110019, India
Tel.: +91-11-26275066, 65698950
Fax: +91-11-26274349
Email: neumech@nda.vsnl.net.in

 
Delegate Name: ____________________________________________ 
Mailing Address :

____________________________________________

____________________________________________

City : _____________________________ 
State : _____________________________ 
Pin Code: _____________________________ 
Country : _____________________________ 
Phone (Office) : _____________________________ 
Phone (Home) : _____________________________ 
Mobile : _____________________________ 
Fax : _____________________________ 
Email : _____________________________ 
Preference 1:
Hotel Name: _______________________________
Preference 2:  
Hotel Name: _______________________________
Number of Rooms : _____________________________ 
Number of Persons : _____________________________ 
Occupancy (Tick as applicable)
Single
Double
Date of Check In : _____________________________ 
Date of Check Out : _____________________________ 
Total No. of nights : _____________________________ 
Arrival Details :  
Date of Arriva l: _____________________________ 
Flight No : _____________________________ 
Time of Arriva l: _____________________________ 
Arriving from : _____________________________ 

Departure Details :

  
Date of Departure : _____________________________ 
Flight No : _____________________________ 
Time of departure : _____________________________
leaving fo r: _____________________________
Payment Details (Tick as applicable) :
Cheque/DD payable at par in New Delhi in favour of “Neumech Events”
Cheque / Demand Draft No : _____________________________
Dated : _____________________________
Bank Name : _____________________________
Amount : _____________________________
 

To make payment by Credit Card / Swift Transfer Please visit www.conferenceindia.org

 
Delegates Signature ____________________
 

Print This Form