:: Dr.Prithika Chary :: Consultant Neurologist and Neurosurgeon, Creative Karma, Epicenttre, Epicentre, ADL Neurotech, FRIENDS Trust::

Name of Organization *
Contact person’s name
Contact person’s title
Contact person’s phone	- - ( country code-city code-phone number)
Contact organization’s address
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Date
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Support facilities available		Overhead projector/Slide projector/Computer & LCD projector/Black board, White board/Paper flipchart/Other
Mike arrangements		Collar mike/Cordless mike/Fixed mike
Approximate number of attendees
Composition of anticipated attendees
Charitable		Yes/No
Time allowed for lecture
Accommodation provided		Yes/No
Name of hotel,address & phone number
Transport provided	Yes/No
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