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DECLARATION FORM We hereby confirm our participation in the 4th International Congress on the 21st, 22nd and 23rd May2010 at Hotel La lit, Conn aught Place, New Delhi. We agree for sponsorship of
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Implantology AJAY 4th SHARMA E-105 DELHI-110092 VIHAR PREET ANCILLIARY DDcheque 23rd May-2010 Connaught 22nd 21st Lalit favouring herewith Rs mails sponsorship Delhi payable specify INDIA enclosed

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