APCRICON 2016

9th&10th July 2016, Bangalore

REGISTRATION FORM
Name
Designation
Organization/Institution
Residential Address
Mobile Number
E-mail
APCRI Membership Number
Name of the State Medical Council/
Veterinary Council &
Registration Number
Pre-Conference C.M.E
Conference

Registration for
Payment Details: Total Amount
DD No./UTR No.
(UniqueTransaction reference No.)
Food Preference

Vegetarian Non Vegetarian

Name shall be written clearly in capital letters only, with a space as separation. The same will be printed
on the certificate as per Karnataka Medical Council requirements. Corrections shall not be entertained.

Post Graduate students should enclose permission letter from their respective HoDs.
Spot registration: Conference bags and other materials are not provided.
Payment Options
Demand Draftin favor of APCRICON 2016to be sent by post/courier to:
Dr. Gangaboraiah,
Treasurer, APCRICON 2016
Department of Community Medicine,
Kempegowda Institute of Medical Sciences (KIMS),
Banashankari 2nd Stage, Bangalore 560070
Mobile No.: 09845128875
OR

RTGS transfer to Punjab National Bank,

Banashankari 2nd Stage branch, Bangalore - 560070
Name of the account: APCRICON 2016
Account No:04623000100024093
IFSC code:PUNB0462300

Association for Prevention & Control of Rabies in India (APCRI)

Application for Young Scientist Award 2016
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Name:_______________________________________________________________________________
Date of Birth & Age: ____________________;________Yrs
3. Sex: ________________________
Institutional Address: ___________________________________________________________________
Qualification(s): _______________________________________________________________________
Present designation: ____________________________________________________________________
Phone No.s: (Office):__________________ (Res): ________________ Mobile: ___________________
Fax: ______________________ 9. Email: _______________________________________________
Topic of research (s) work undertaken (enclose only details of work done in the field of rabies): _______
____________________________________________________________________________________
Place & year during which research was undertaken: __________________________________________
Training undergone (relevant to rabies): ____________________________________________________
Total years of Experience: ___________ Teaching: ______________ Research: ________________
Awards/Medals/Fellowship received (enclose copies): _________________________________________
Total number of research papers published (relevant to rabies): __________________________________
National Journals: ________________________. International Journals: _________________________
Any other information in support of research work: ___________________________________________

(Signature & Seal of HoD)(Signature of the applicant)

Guidelines for applying for Young scientist award in the field of rabies research.
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The applicant can either be a Medical or Veterinary person with a post graduate degree/ diploma.
Age of applicant should not be more than 40 years as on 1st July 2016.
Applicant with full details of the research work in the field of rabies should be submitted to Secretary General,
APCRI(in sealed cover) on or before 31st May, 2016.
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Research work(s) carried out as a project or departmental research or P.G. researches are eligible for
consideration.Submit a copy of the research work done for claiming the award.
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The research should have been carried out in India,during the proceeding 5 years.
6. Attested copy of age proofshould be enclosed along with the application. (10th std. marks card/etc.)
7. Only life members of APCRIare eligible to apply for the award.
8. The Award committee of APCRI reserves the right to defer the award if suitable candidates are not available in the
particular year and the decision of the committee will be final.
9. The award carries a prize of Rs. 5,000/-, a citation & a certificate which will be given during the conference.
10. The young Scientist who applies & gets the award shall make the presentation of his/her work during the annual
conference of APCRI during the same year. He/she will be given Travel (2 tier AC train) fare & an amount of Rs.
3,000/- towards accommodation & incidentals.