Requisition Proforma for Organizing the C.M.E. Program

1. Name of the Organization/Institution __________________________________

2. Name of the Organizing Chairperson___________________________________

3. Name of the Organizing Secretary_______________________________

4. Title of the Conference/Symposium/Seminar/Workshop ____________________

    ----------------------------------------------------------------------------------------------
5. Whether Organizing Secretary/Chairperson is a member of the IAP ? Y/No

6. Duration of the Activity ---------------------------------------------------------------

7. Registration Fee per delegate Rs. __________________________

8. Venue of the Conference ------------------------------------------------------

I/We Dr._____________________________________Organizing Secretary/Chairperson

of the CME Program entitled _______________________________________________

are willing to donate the Rs. 5,000/- or 10% of the Registration Fee, whichever is more,

to I.A.P. Delhi, within 3 months of the completion of the event.

Date: Signature of the Org.Secretary/Chairperson

/CME requisition form/