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Fellowship Course ofIndian Association of Gastrointestinal Endo Surgeons
23 - 25 June 2016
FIAGES KOLKATA 2016
Venue : Medical College, Kolkata
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IAGES EXECUTIVE COMMITTEE
FOUNDER PRESIDENT & TRUSTEE
Dr. Tehemton E. Udwadia
PRESIDENT
Dr. Ramesh Agarwalla
PRESIDENT ELECT
Dr. A Zamer Pasha
IMM. PAST PRESIDENT
Dr. Abhay N Dalvi
HON. SECRETARY
Dr. Sayandev Dasgupta
HON. TREASURER
Dr. Ramen Goel
ADVISORY COMMITTEECHIEF TRUSTEE
Dr. Kuldip Singh Dr. Pradeep Chowbey
Dr. K. Ravindranath
Dr. B. Krishna Rau
Dr. H. G. Doctor
Dr. M. G. BhatTRUSTEES
Dr. Ajay Kriplani
Dr. Suresh Deshpande
Dr. John Thanakumar
Dr. V Venkatesh
VICE PRESIDENTS
West Zone :
Central Zone :
South Zone :
North Zone :
East Zone :
Dr. Sunil D. Popat
Dr. Amitabh Goel
Dr. Ashwin Masurkar
Dr. Sumeet Shah
Dr. Satyapriya De Sarkar
EXECUTIVE COMMITTEE MEMBERS
West Zone East Zone
Central Zone North Zone
Dr. Aparna Despande
Dr. Roy Patankar
Dr. Pramod Shinde
Dr. Jaya Maheswari
Dr. C R Das
Dr. Sreejoy Patnaik
Dr. Vijay Mittal
Dr. Sarfaraz Baig
Dr. Rakesh Shivhare
Dr. Achal Gupta
Dr. Sumit Shukla
Dr. Siddharth V Tamaskar
Dr. Vandana Soni
Dr. Manish Baijal
Dr. Subhash Aggarwal
Dr. Meenakshi Sharma
South Zone
Dr. K Govindraj
Dr. L P Thangavelu
Dr. T Siva Kumar
Dr. Easwaramoorthy
CO-OPTED MEMBERS
Dr. Rajesh Khullar, Dr. Kona Kumari Laxmi, Dr. Suresh Vasistha, Dr. Navneetha Krishnan
Dr. Deepraj Bhandarkar, Dr. Satish Midha
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Dear Friends & Colleagues,
It is a pleasure and privilege to invite you to “FIAGES KOLKATA – 2016”, which is going
to be held from June 23 -25 2016 at Medical College and Hospital, Kolkata.
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The Indian Association of Gastro-Intestinal Endo Surgeons (IAGES) is a vibrant and
dynamic organization of more than 5000 members with the vision of promoting and
spreading the art and science of laparoscopic and endoscopic surgery throughout
India and abroad. FIAGES is the certified fellowship of the IAGES. The Fellowship of
the IAGES is unique since it takes into consideration the seniority and contributions of
the senior surgeons and at the same time assesses the competence of the young
surgeons by an examination after a structured course. The aim of the fellowship is to
establish uniformity and highest standards of practice and training in endosurgery.
“FIAGES KOLKATA – 2016” will be a three day course comprising of Didactic Lectures,
Live Laparoscopic Surgery Workshop, Hands on Laparoscopic Training on
Endotrainers and Unique Meet the Professor sessions. The teaching and training will
be followed by written and assessment of the candidates. On successful
completion of the course, the candidates will be eligible to receive the much coveted
FIAGES certificate at the convocation ceremony in next IAGES Annual Congress.
Please note that IAGES Membership is mandatory prior to taking up the FIAGES
certification course.
The venue for the course is Medical College, Kolkata in the heart of Kolkata. It has all
the facilities with ample parking space.
We look forward to welcome you at FIAGES KOLKATA-2 016.
ORGANISING COMMITTEE
DR. T. E. UDWADIA
(FOUNDER PRESIDENT)
DR. RAMESH AGARWALLA
(PRESIDENT)
PROF. K. N. DAS
(ORGANISING CHAIRMAN)
DR. SAYANDEV DASGUPTA
(HON. SECRETARY)
PROF. GARGI BANDYOPADHYAY
ORGANISING SECRETARY
DR. SATYAPRITYA DE SARKAR
VICE PRESIDENT (EAST ZONE)
DR. SAURAV GHOSH
TREASURER
DR. SUBHASH KHANNA
(FIAGES CONVENOR)
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Course DetailsIAGES Fellowship Course
Course Structure
Non Examination Category
Examination Category
Written examination
Practical Examination
The skill assessment on Endo trainer
Interview / Viva
I AGES will conduct a 3 days fellowship course, at Kolkata from 23 to 25 June 2016.
The course will be a balanced mix of didactic lectures by eminent faculties with ample time for
discussions, video presentation, open house sessions, symposia and direct informal interaction of
groups with eminent faculty [Meet the Professors], Participants will get ample time on Endo trainer
under close guidance and supervision of faculties to improve their hand eye coordination by
structured exercise. Besides the allotted time, there will be liberal availability of Endo trainers at
other times. The objectives of the course are to impart and update with many unique features in this
course to make it more useful, convenient and memorable for you.
For non Examination Category, minimum of 10 years of experience of Laparoscopic Surgery is
required after the post graduation. You are expected to have performed over 250 laparoscopic
procedures. Submission of some evidence or under taking is required to substantiate your
claim of having vast experience in the field of minimal access surgery. The candidates registered
in this category are required to attend all the lectures on 1st and 2nd day and live workshop on
3rd day. A formal interview of these candidates will be taken by FIAGES board members.
For examination category, the candidates are required to have minimum of 2 years of
experience in, Laparoscopic surgery after post graduation in surgery. They are expected to
have performed over 25 laparoscopic procedures independently or jointly. They have to attend
proceedings on all 3 days including the endo trainer session and meet the professor session. On
the 3 day they will appear for the examination. The endo trainer sessions are very important
part of the fellowship course. During the session they will be trained in performance of
specified tasks and specific exercise including Endo knotting and suturing. On the last day the
evaluation will be on the CME exercise.
There will be short essay type question &/or MCQs. Theory Exam will be 100 Marks &
Candidates are required to obtain minimum of 50 % marks to pass. The answer should be brief
and to the point. The answer sheets are checked by five faculty members. Each answer sheet is
checked by one examiner only.
[It has two parts]
(1) is based on performing simple to advanced
exercise, approximately 10 minutes for each candidate. Maximum of 50 marks are
allotted on Endo trainer assessment. Five faculty members are deputed as examiner. Each
candidate is examined by one examiner only.
(2) approximately 10 minutes for each candidate. The candidates are
divided into batches and are interviewed by two or more senior most faculty members of
IAGES depending upon the number of candidates. Maximum of 50 marks are allotted for
the interview.
Total marks for practical examinations are 100 [Endotrainer assessment 50 marks & interview
50 marks]. A minimum of 50 marks are required to pass separately in practical examination
combing the endotrainer assessment and interview. No Marks for the attendance. Attendance
is Compulsory.
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IAGES membership is compulsory for Fellowship course.
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Criteria of FIAGES Course
IAGES membership is mandatory.
Candidates need to have 2 years of experience post MS/DNB by May 2016.
Non members will submit duly filled IAGES membership form with passport size photo. A
separate DD of 4,000 in the Name of IAGES before or along with Registration.
Attach the MBBS, MD or DNB, Medical Council Registration Certificate (Kindly enclose Xerox
copy)
Cases of laparoscopic appendectomy, laparoscopic cholecystectomy, laparoscopic repair of groin
hernia both TEP and TAPP, laparoscopic repair of ventral/incisional hernia and other cases
subject to availability.
Trainees will get ample opportunity to practice knotting and suturing in the lap trainer under the
direct supervision of Faculty on day 1 and day 2. Final practical assessment of suturing skill will be
on day 3.
It is a good opportunity for young surgeons to discuss freely on common issues in both basic and
advanced laparoscopic surgery. Delegates can choose the appropriate session to attend to clarify
their doubts in the particular area like Lap chole session, Lap Hernia session, Lap Solid organ
session, Session on setting up laparoscopic unit and sterilization issues etc.
Attendance is compulsory for all FIAGES course participants on all days.
Participants are requested to a day which is mandatory and stay in the
hall till the proceedings are over and at the end.
The participants are requested to reach Kolkata on the evening of 22nd June or in the
morning of 23rd June before 8.00 A.M.
Comprehensive Laparoscopic Surgery (can be downloaded from the IAGES website)
Textbook of Laparoscopy Surgery: Dr. T. E. Udwadia
The SAGES Manual
Laparoscopic Surgey: Dr. Alfred Cuschieri
Laparoscopic Surgery: Zucker & Baily
A fellowship certificate will be given only in person to the successful candidate in convocation
ceremony during the national conference of IAGES. A certificate of attendance will be given at the
end of this course.
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Live Operative Workshop
Lap Trainer Session
Meet the Professor Session
Instruction to Course Participants
sign in four times
sign out
Recommended reading for the FIAGES course.
Award of Fellowship Certification
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Registration Fee
ELIGIBILITY 2 YEARS POST MS/DNB
COURSE FEES Rs 12000/-
MEMBERSHIP FEES Rs 4000/-
sFOR ALL OTHER ATTENDING DOCTORS REGISTRATION FEES R . 2500/-
Note
"FIAGES KOLKATA 2016" KOLKATA
Name of A/c : FIAGES KOLKATA - 2016
A/c No. : 0835050013527
Bank: UBI Bank
Branch: MCH Branch
IFS Code: UTBIOMCHA13
For IAGES Membership : DD of an amount of 4000/- drawn in favour of
IAGES - Mumbai, payable at Mumbai.
IAGES 2017 at Hyderabad
: Non IAGES members cannot appear for fellowship exam. They can attend the
CME and workshop.
Demand draft / at par cheque should be made in favour of
Payable at or Can be sent by NEFT:
Spot registration for the fellowship course and the live workshop may kindly be
avoided.
Non IAGES member can send the form of IAGES membership with duly filled
Registration form to become eligible for the fellowship and avail registration fee as
IAGES members.
For Membership of IAGES please log on www.iages.in
Kindly make separate DD for membership of IAGES and for FIAGES course.
All Successful fellowship candidates have to register for the National Conference,
for award of the fellowship certificate.
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For Registration you may kindly contact : Mrs. Rakhi Saha - 9836765353
Please fill in the form (FIAGES & IAGES Membership) and attache the rquired
document and DD and kindly send it back to the following address
Prof. Gargi Bandyopadhyay, Organizing Secretary
50/1B, Harish Mukherjee Road, Kolkata - 700 025, West Bengal, India
Conference Secretariat:
Prof. Gargi Bandyopadhyay
Organising Secretary
Department of Surgery, Medical College, Kolkata
88, College Street, Kolkata - 700 073
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DAY 1, FRIDAY , 2016
DAY 2, SATURDAY , 2016
NO FANCY SURGERY DEMO - ABSOLUTELY BASICS
23 JUNE
24 JUNE
DAY 3 25 JUNE 2016 OPERATIVE WORKSHOP
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08.00AM - 09.00AM REGISTRATION
08.55AM - 09.00AM Introduction
09.00AM - 09.20AM History of Laparoscopy
09.20AM - 09.40AM Endo-Vision System
09.40AM - 10.00AM Hand Instruments, Accessories & Ergonomics
10.00AM -10.20AM Sterilisation of Instruments & Maintainance
10.20AM - 10.40AM Energy Sources in Laparoscopy
10.40AM - 11.00AM COFFEE BREAK
11.00AM -11.20AM Training in Laparoscopy & Starting A Laparoscopy Unit
11.20AM - 11.40AM Peritonial Access, Access Complications & Prevention
11.40AM - 12.00PM Physiology of Pneumoperitoneum & Anaesthesia in Laparoscopy
12.00PM - 12.20PM Tissue Approximation & Endosuturing
12.20PM - 12.40PM Standard Lapchole
12.40PM - 01.00PM Difficult Cholecystectomy, Tips & Tricks
01.00PM - 01.30PM LUNCH
01.30PM - 01.5OPM Management of Lap Biliary Injuries
01.50PM - 02.10PM Management of CBD Stones in Era of Laparoscopy
02.15PM - 02.45PM Panel Discussion on Complications of Lapchole
02.45PM - 03.05PM Lap Appendicectomy
03.05PM - 03.25PM Emergency Laparoscopy (Other than Appendix)
03.25PM - 03.45PM Inguinal Anatomy
03.45PM - 04.05PM TAPP
04.05PM - 04.25PM TEP
04.30PM - 05.30PM MEET THE PROF & ENDOTRAINER SESSION : 1. GB : 2. Hernia : 3. Basics & Appendix
05.30PM - 06.30PM INAUGURATION
08.00AM - 09.00AM MEET THE PROFESSOR
09.00AM - 09.20AM Prosthetic Materials and Fixation Devices in Hernia Surgery
09.20AM - 09.40AM Lap Ventral Hernia (IPOM)
09.40AM - 10.10AM Panel Discussion on Complications of Lap Hernia Surgery
10.10AM - 10.30AM Laparoscopic Surgery for Esophagus & Stomach (Benign)
10.30AM - 10.50AM Laparoscopic Surgery for Esophagus & Stomach (Malignant)
10.50AM - 11.10AM Laparoscopic Surgery for Spleen & Adrenals
11.10AM - 11.40AM COFFEE BREAK
11.40AM - 12.00PM Lap Surgery of Liver & Pancreas
12.00PM - 12.20PM Lap Surgery for Benign & Malignant Diseases of Large Intestine
12.20PM - 12.40PM Lap Gynecological Surgery for General Surgeons
12.40PM - 01.00PM Lap Urological Surgery
01.00PM - 01.20PM Laparoscopic Obesity & Metabolic Surgery
01.20PM - 02.00PM LUNCH
02.00PM - 02.2OPM Medico-Legal Aspects
02.20PM - 02.40PM VATS/ Thoracoscopic Surgery
02.40PM - 03.00PM Laparoscopic Paediatric Surgery
03.00PM - 03.20PM Robotic Surgery - Today & Tomorrow
03.20PM - 03.40PM Video Recording, Editing & Paper Presentation
04.00PM - 06.00PM Theory Exams - Exam Category Interview - Non Exam Category
08.30AM - 01.00PM Standard Lapchole, Exam Category Interview at the same time
Standard Lap Appendix, TAPP, TEP, Small defect Ventral Hernia - Optional
Theory Paper Setter - Dr. Subhash Khanna
Theory Paper Examiners : Dr Subhash Khanna + To be decided
Endotrainer Examiners To be decided
Oral Examiners : Dr. Subhash Khanna + To be decided
Scientific Programme
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Working Committee
PROF. GARGI BANDYOPADHYAY
ORGANISING SECRETARY
Prof. Bitan ChattopadhyayProf. Manju BanerjeeProf. M L SahaProf. D K SarkarProf. Anil SahaProf. N. N. MukhopadhyayProf. Gautam DasProf. Nemai C NathProf. Q M RahamanProf. Hiranmoy BhattacharyaProf. D RoyProf. S S Bhoj
Prof. Tamonas ChaudhuriProf. Saibal MukherjeeProf. Ajoy RoyProf. Anil SahaProf. Sukumat MaitiProf. Shibajyoti GhoshProf. S. R. GhoshalProf. Sudev SahaProf. Amitava SarkarDr. Sanjay De BakshiProf. U. BhattacharyaProf. U. De
Prof. Anand SagarProf. Anadi AcharyaProf. T. KhamruiProf. D. KunduProf. M. K. DasProf. Sandip MazumdarProf. Saugata SamantaProf. Sankar Das ChatterjeeProf. Nishit KarmakarProf. Prasanta BhattacharyaProf. Abhimanyu BasuProf. Subhabrata Das
ADVISORY BOARD
LOCAL ORGANISING COMMITTEE
DR. SAURAV GHOSH
TREASURER
PROF. K. N. DAS
ORGANISING CHAIRMAN
Dr. Udipta RayDr. Amarendra Nath SarkarDr. Sudarshan SenDr. T K BiswasDr. Niladri SarkarDr. Dhrubajyoti BhowmickDr. Madhumita MukhopadhyayDr. Krishnendu MukherjeeDr. M. C. JhunjhunwalaDr. S. K. JhunjhunwalaDr. Rabin DebnathDr. V. LakshmanDr. Somdutta LahiriDr. Sandip HalderDr. Ramanuj MukherjeeDr. Nishit Kr. MallikDr. Aswini MalhotraDr. G. S. PiparaDr. S. S. Roy Chowdhury
Dr. C. Roy ChowdhuryDr. Dhritiman MaitraDr. Pankaj SarakarDr. Bidyut BiswasDr. Mriganka GhoshDr. Abhiram MajhiDr. Ajoy Kr. PaulDr. M. N. HaqueDr. L. S. ChenDr. S. N. BasakDr. G. C. DasDr. Mukesh KariaDr. Aniruddha DasguptaDr. Ajoy MondalDr. S. P. BankaDr. Sankar BhattacharyaDr. Sanjay DubeyDr. Yogesh BavisiDr. P. P. Singh
Dr. Saugata DeDr. Md. Raja HaiderDr. Sanjay GuptaDr. S. ChakrabortyDr. T. K. JanaDr. P. K. MishraDr. G. BhowmickDr. Kalyan Kr. SarkarDr. Plaban BiswasDr. H. P. MondalDr. Yatrik BiswasDr. Dwaipayan SamaddarDr. Ajoy Kr. SenDr. Rajat BhattacharyaDr. A. BhartiaDr. Sandip RayDr. Ambar GangulyDr. Nasir Iqbal
DR. SARFARAZ BAIGEXECUTIVE COMMITTEE MEMBER (EAST ZONE)
DR. P. K. NEMANICHAIRMAN, SCIENTIFIC COMMITTEE
DR. ARGHO RAY
WORKSHOP CO-ORDINATOR
CHIEF PATRONS
Prof. Tapan Kr. LahiriProf. Susanta Kr. Bandyopadhyay Prof. Bhabatosh BiswasProf. Niranjan Bhattacharya
PATRONSProf. Urmila Khanna, Prof. Asit Kumar Banerjee, Prof. Dilip Kumar Chakraborty, Prof. Tamal Kanti Choudhury
Dr. Alok Banerjee, Dr. Kalyani Banerjee, Dr. V. K. Bhartia, Dr. S. K. Agarwal, Dr. Om Tantia
Prof. Himadri SenguptaProf. Pallab GhoshProf. Kishore ChowdhuryProf. Gautam Chatterjee
Dr. Tapanjyoti BanerjeeProf. Debasish Bhattacharya
Dr. Arnab GuptaDr. P. B. KarProf. Dibyendu GautamProf. P. G. SarkarProf. P. S. PaulProf. S. Poira
Dr. Purnendu RoyDr. Dipankar SenguptaDr. Sankar MitraDr. R. P. LadhaniaDr. Manas RoyDr. Ashok SarafDr. Pratip SenguptaDr. Prantik ChowdhuryDr. Nilanjan PandaDr. Sanjay SilDr. Kalyan KarDr. Sanjay MandalDr. Santanu KarDr. D. K. ChattopadhyayDr. B. RamanaDr. Sumit GulatiDr. G. S. Bhattacharya
Dr. Rajesh BarasiyaDr. Soumen DasDr. Saumitra ChandraDr. Deb Kumar RoyDr. Abir BanerjeeDr. Dipankar SarkarDr. Subhasis SahaDr. Debasis RoyDr. Naba Kumar SahaDr. Sumit ChaudhuryDr. Swaraj BhattacharyaDr. Moinul HasanDr. Pinaki BanerjeeDr. Ratnajit DasDr. Bikash Ghosh
Fellowship Course of Indian Association of Gastrointestinal Endo Surgeons
FIAGES KOLKATA 2016
Venue : Medical College, Kolkata
Name ...............................................................................................................
Age / Sex ...................
Address ............................................................................................................
............................................................................................................
Phone : [Hosp.).............................[Resi.] ......................... Mob............................
IAGES Membership No.:............................PG Student Non Member
Medical Council Reg. No.: ....................................................................................
Accompanying Person :........................................................................................
Total Amount:.....................................................................................................
Mode of Payment: Cash / at par Cheque / Demand Draft on FIAGES KOLKATA - 2016
No.........................................Dated........................ Payable at Kolkata
or can be sent by NEFT:
Name of Bank: UBI Bank
A/c No.: 0835050013527
IFS Code: UTBIOMCHA13
Branch: MCH Branch
Name of A/c.: FIAGES KOLKATA - 2016
Date: Signature
Organising Secretary
Department of Surgery, Medical College, Kolkata
88, College Street, Kolkata - 700 073
M/F Qualification : MS Mch DNB
City: ................................................ Pin : .............................................
ELIGIBILITY 2 YEARS POST MS/DNB
COURSE FEES Rs. 12000/-
MEMBERSHIP FEES Rs. 4000/-
s
REGISTRATION FEE
Prof. Gargi Bandyopadhyay
FOR ALL OTHER ATTENDING DOCTORS REGISTRATION FEES R . 2500/-
Note : Non IAGES members cannot appear for fellowship exam. They can attend the
CME and workshop.
23 - 25 June 2016
[Please see overleaf for the instructions]
Step 1:
Step 2:
To become IAGES Member:
Note :IAGES Membership : DD to be made in favour of IAGES - Mumbai, payable atMumbai.
Step 3:
Step 4:
Step 5:
Fill this Registration form. Direct Money Transfer;
A/c. No. :
IFSC :
Fill the IAGES membership form and attach DD of 4000 in the name of "IAGES -Mumbai payable at Mumbai. Attach all the necessary photocopied documents -namely, postgraduate degree certificates and Medical council registration. No NonIAGES members would become eligible for FIAGES fellowship examination and alsoavail registration fee as IAGES members.
Send both the forms and their DDs to the conference Secretariat and receive thereceipt either by post or in Person
Make your own Travel and Accommodation arrangements. Call Event Managers forany help. Exam category candidates may have to stay late on evening of last day for vivaand hence advised to plan return travel accordingly.
After the successful completion of course, register to attend the IAGES AnnualConference at Hyderabad to receive the fellowship certificate at the convocationceremony.
NAME OF A/C. : FIAGES KOLKATA - 2016
0835050013527
UTBIOMCHA13
UBI Bank
MCH Branch
BANK :
BRANCH :
`
Steps of Registration Process
Please fill in the form and send it back to the following address
Prof. Gargi Bandyopadhyay, Organizing Secretary
50/1B, Harish Mukherjee Road, Kolkata - 700 025
West Bengal, India
INDIAN ASSOCIATION OF GASTROINTESTINAL ENDOSURGEONS
To
The Hony Secretary IAGES
Dear Sir,
I wish to apply for active / student / associate / international / corporate membership of the IAGES.
Name
(Surname) (first name) (middle name)
Date of birth ................................................. Sex M/F ............... Citizenship passport No ..............................................
Permanent Address .........................................................................................................................................................
City ...................................................................... State....................................................... Pin ......................................
E-mail .......................................................................................... Website ......................................................................
Telephone/ Fax City Code ..........................................
Office Residence
1) ..................................................... 1) .......................................................................
2) ..................................................... 2) ........................................................................
Cellular ............................................. Fax No. Off..................................................... Res ........................................
Medical Registration No ......................................................................................... Country State .................................
Academic Qualification Year University / Institution
Institution Duration From (Date) Teacher
..................................... ................................ ........................... ................................
..................................... ................................ ........................... ................................
Designation Institution From To
Personal Particulars (in block Letters)
Training In Endoscopic Surgery / Procedures
Appointments / Experience
..................................... ................................ ........................... ................................
..................................... ................................ ........................... ................................
..................................... ................................ ........................... ................................
..................................... ................................ ........................... ................................
..................................... ................................ ........................... ................................
..................................... ................................ ........................... ................................
..................................... ................................ ........................... ................................
..................................... ................................ ........................... ................................
..................................... ................................ ........................... ................................
APPLICATION FOR MEMBERSHIP
Serial No............................ Dated............................. Passport Size
Photo
Membership Of Other Associations/Societies
Sponsors
Instruction for application. Please enclose the following:
For Office Use
Association/Society Membership No.
..................................................................................... .............................................................................
I, hereby certify that the above information is correct to the best of my knowledge and I agree to Abide by rules and bye-
laws of the India Association of Gastrointestinal Endo-Surgeons.
Date .............................................................. Signature .............................................................
Address Of the Institution/Hospital Attachment
........................................................................................................ Tel. No .........................................................
........................................................................................................ Fax ..............................................................
1. Name 2. Name
Membership No. of IAGES Membership No. of.lAGES
Address: Address:
Signature Signature
• Attested photocopies of all certificates of academic qualification & registration of medical council.
• Two copies of passport size photograph in colour
•
• Return the completed application from to:
• Dr. Sayandev DasGupta
Hon Secretary IAGES
107 Ballygunge Gardens
Kolkata - 700029
Mob 9830030390
Email: sayandev.dasgupta@gmail.com
Application No ....................................................Received on ....................................... Submitted .................................
Approved/rejected on ........................................ Membership subscription of Rs./$ ........................................................
Received on ........................................................Vide cheque / demand draft No ............................................................
Dated .................................................................Drawn on ..............................................................................................
Membership No ...............................................................................................................................................................
..................................................................................... .............................................................................
Demand draft for Rs. 4000/- drawn in favour of "lAGES-Mumbai, payable at Mumbai. Personal cheques,
bankers cheques, etc are not acceptable.
Recommended