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Avanz Bio Pvt. Ltd. Achieving Excellence Through Biosciences
No. 12, M.E.S Road, East Tambaram, Chennai-600059.
Phone: 044-22390235, Mobile: +91-8946098013, +91-9382869278
E-mail: [email protected], Web: www.avanzbiopvtltd.com
Workshop Registration Form
Name: Dr. / Mr. / Mrs. / Ms. …………………………………………………………………………………………..
Designation: …………………………….….. Course of Study: ………………………………………………….....
Institute: ……………………………………………………………………………………………………………….
Contacts: Cell: ……………………………..…………… E-mail: ……………………………………………….......
Address for Communication: ………………………………………………………………………………………...
………………………………………………………………………………………………………………………….
Hands-on Training: Animal Cell Culture
Stem Cells and Regenerative Medicine
Molecular Biology
Plant Tissue Culture
Batch No & Date: ……………………………………………………………………………………………………..
Mode of Payment (Internet Banking / Google Pay / Demand Draft / Cash): ………………………………….....
Internet Banking: Avanz Bio Pvt Ltd, Union Bank of India, C A/C. No. 500801010035433, IFSC UBIN0550086,
East Tambaram Branch, Cell 9382869278.
Google Pay: +91-9003024757 (Aarthi Raju).
Demand Draft: In favor of “Avanzbiopvtltd” payable at “Chennai”.
Place:
Date: Signature of the Candidate
For Office Use Only
Date of Payment Mode of Payment with details Amount
Paid
Receivers
Signature
Total Rs.
