Endorsement for Scientific Programs Application Form

(All fields marked with * are required)

Movement Disorders Society of India Member Details *

Name Of Member: *

Membership Type: *

Membership Number: *

Email Id: *

Mobile Number: *

Program Details *

Name of the Scientific Program (Conference/ CME/
Workshop/ Symposium/ Teaching Course/ etc.) *

From Date *

To Date

Venue *

Objectives of the meeting * 0/400

Degree Course for which thesis has been/ is being submitted *

Target audience/ delegates *

Expected number of delegates *

Details of Registration charges for the Delegates * 0/400

Number of Faculty (National / International / Both) *

Source(s) of Funding: *

Is the Scientific Program offering CME credit points
from Medical Council? *

Yes No

Is the proposed Scientific Program seeking/ offered
endorsement by any other Scientific Organization/ Society? *

Yes No

Upload Scientific Program File

(Only JPG, JPEG, PNG & PDF file allowed, up to 2 MB only) *

Upload

Upload Brochure File

(Only JPG, JPEG, PNG & PDF file allowed, up to 2 MB only) *

Upload

I confirm that the above information is true and I, on behalf of the Organizing Committee, agree with the following terms and conditions of MDSI for endorsement of the Program by MDSI:

i. A Scientific Report on the program and a short summary of the income and expenditure for conducting the program will be sent to the MDSI within 3 months following the Program.
ii. A generous donation from the balance money after the Program will be made to the Corpus Fund of MDSI, within 3 months following the Program.