14TH WORLD CONGRESS

OF THE

INTERNATIONAL SOCIETY FOR LASER SURGERY AND MEDICINE

ORGANISED BY :  THE INDIAN ASSOCIATION OF LASER SURGERY AND MEDICINE

27 - 30th AUGUST, 2001, CHENNAI, INDIA

SPONSORSHIP / EXHIBITION APPLICATION FORM

Please complete this form using BLOCK LETTERS or TYPEWRITER.

Company Name : _______________________________________________________________________________

Address : _____________________________________________________________________________________

City : __________________________________  Country : _____________________________________________

Telephone : _____________________________  Telefax : ______________________________________________

Person to Contact : _____________________________________________________________________________

Position in Company : ___________________________________________________________________________

EXHIBITION REQUIREMENTS :

Booth(s) No. ___________________________________________________________________________________

PRODUCTS TO BE EXHIBITED :

Please specify : _________________________________________________________________________________

_______________________________________________________________________________________________

PAYMENTS :

Rental fee must accompany with deposit of 50% fee per booth booked. Payments should be made through Cheque /Bank Draft, drawn in  favour of  "Dr. B.KRISHNA RAU ISLSM 2001, CHENNAI".

Cheque / Bank Draft No. _______________________________________ Amount (U.S.$) ______________________

Name of the Bank ________________________________________________________________________________

Country : _______________________________   Dated : ________________________________________________

Exhibitor Names : 1) ______________________________________________________________________________

2) ______________________________________________________________________________

3) ______________________________________________________________________________

Signature : ___________________________                                         Date : ______________________________

Please return this copy to :  THE CONGRESS SECRETARIAT,                                          Department of Surgery - D2 Ward,                                          Sri Ramachandra Medical College & Research Institute,                                          Porur, Chennai (Madras) - 600 116. INDIA                                          Phone : 91-44-4765856    Fax : 91-44-4767008