Offline Registration Form

First Annual National Scientific Conference of

Epidemiology Foundation of India

(EFICON-2020)

11th – 12th APRIL, 2020

Registration Form

 

1. Name:                 First:                            Last:

 

 

2. Designation:

 

 

 

3. Institution/Organization Address:

 

4. Complete Address for correspondence:

 

 

5. Contact No.  Mobile:                           Landline:                               

 

 

6. Email ID:

 

 

7. Abstract Submitted        :         Yes/No,       If yes    :         Oral/Poster  

 

 

Signature:______________________

 

Name of the Presenter:

Date:                          

 

 

Address for Correspondence

Dr. Pradeep Aggarwal

Joint Organizing Secretary &

Associate Professor

Department of Community and Family Medicine

All India Institute of Medical Sciences, Rishikesh, Uttarakhand

Email: eficon2020-aiims-rishikesh@gmail.com

Ph: +91- 9837215747