FFE Registration Form Please Email us the details of people attending the conference In case of Group bookings (multiple delegates) please fill in separate forms giving individual details of delegates. A single cheque for total amount for the total number of delegates can be sent. Delegate Fees for Service Provider Companies - Rs.7500/- Delegate Fees for Pharma Companies upto 3 delegates - Rs.6500/- Prices are inclusive of Power Breakfast with Decision Makers, Networking Lunch and High Tea For the invoice/bill generation – let us know the - Name of the Person, Company Name & Company Address Cheques should be made in the name of “Knowledge Ventures” and couriered to : Mr.Arvind Nair, FFE 2012 Secretariat, B/205, Ahimsa Enclave, Off New Link Road, Chincholi, Malad West, Mumbai 400064. First Name Last Name Gender Company Name & Address Pin Telephone Mobile Email Designation / Title Payment Mode www.medicinman.net F M Page 1