THE TNAI TAMILNADU STATE BRANCH

XXIV TNAI BIENNIAL CONFERENCE AT

OMAYAL ACHI COLLEGE OF NURSING

NO. 45, AMBATTUR ROAD, PUZHAL, CHENNAI – 66

TEL: 26591617, 26591618, Fax: 26591616

Theme: Quality Clinical Practice: Nurses’ Concern

REGISTRATION FORM

Name : Mr. /Ms. _____________________________________

Qualification & Designation : _____________________________________________

Institution with Address : _____________________________________________

TNAI Number : _____________________________________________

Hostel Accommodation Required: Yes / No; If Yes

Presenting Paper/Poster: Yes / No; If yes, Abstract sent: Yes / No

Remittance Details

Registration fees : _________________

Scientific Presentation Fees : __________________

Food & Hostel Accommodation: Rs.350 x days

Total Amount: _________ DD No: ____________ dated: ________

Drawee Bank___________ No. of Participants: __________

Contact No.* : Office No._____________ Mobile No. __________________

Email * : ______________________ Fax No. _____________________

Signature with Date :

Note: * Mandatory- for further correspondence

Xerox of registration forms can be used.

Date & Time of Arrival: _________________________________

Date & Time of Departure: ________________________________