REF: Activities : Publications

10th Residents' Review Course - 5th October to 8th October 2006

The cost of course material is Rs 200.

An additional Rs 50 as courier charge would be added to the above mentioned amount.

The Demand Draft should be in the name of Radiology Education Foundation and sent to:
Radiology Education Foundation
F-Bhaveshwar Vihar, Sardar V.P.Rd.,
Mumbai-400 004.
Tel 022-66173333

Attn: Ms. Shamina
Fax 022-2382-9595

First Name:

Last Name:

Address:

City:

State :

Pin Code:

E-mail :

Contact Tel. No. :

Payment Mode :

Credit Card *(New)
[Please see instructions below]

If paying by DD,
Demand Draft No:
Date:
Bank:
Amount:	Rs.

Merchant account,
Credit Card Processing
Payment Gateway

*Credit Card payment: REF is pleased to announce that we now accept national and international credit cards! The transaction is secure (you will see the url begin with 'https') and done through ICICI and its agent www.ccavenue.com. The charge on the credit card statement will say www.ccavenue.com. After you select credit card and click on Submit, you will be redirected to the ccavenue/ICICI site. Please fill up details and follow instructions - the steps are easy. As soon as we get intimation about your payment, you will be issued the registration number by email, and this will serve as your receipt.

To pay by Cash or Demand Draft please print the form, fill it up with the relevant details and mail it to the address given above. Please write your name on the reverse of the DD. Please fill in the following:
DD No:
Date:
Bank:
Amount :