Home Program Register Dr Robin Mann Suresh Lulla About BestPrax Club Venue Details Contact Us   Registration Fees Registration Fee - INR 10,000 + 15% Service Tax = INR 11,500 Payment should be made by At Par Cheque/Demand Draft in favour of ‘BestPrax Club Pvt. Ltd.’ and couriered to: BestPrax Club Pvt. Ltd., 4B Sindhu House, Nanabhai lane, Fort, Mumbai - 400 001 Nominating Authority Title* Please select your title Mr Ms Dr Prof. Other please specify* First Name* Last Name* Designation* Company* Site / Unit Address* City* Pin* STD Code* Phone* Direct Number Mobile* Official Email* Personal Email Nominations 1. Title* Please select your title Mr Ms Dr Prof. Other please specify* Name* Designation* Site / Unit Address*   same as above City* Pin* STD Code* Direct Phone* Mobile* Official Email* Personal Email 2. Title Please select your title Mr Ms Dr Prof. Other please specify Name Designation Site / Unit   Address   same as above City Pin STD Code Direct Phone Mobile Official Email Personal Email 3. Title Please select your title Mr Ms Dr Prof. Other please specify Name Designation Site / Unit   Address   same as above City Pin STD Code Direct Phone Mobile Official Email Personal Email 4. Title Please select your title Mr Ms Dr Prof. Other please specify Name Designation Site / Unit   Address   same as above City Pin STD Code Direct Phone Mobile Official Email Personal Email 5. Title Please select your title Mr Ms Dr Prof. Other please specify Name Designation Site / Unit   Address   same as above City Pin STD Code Direct Phone Mobile Official Email Personal Email Total Amount Due: BestPrax Club Pvt. Ltd. | 4B Sindhu House, Nanabhai Lane Fort, Mumbai 400 001, India | T: (91-22) 6634 8701 | E: inbox@bestprax.com