Delegate Registration Form
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The document is a registration form for the India Investment & Innovation Summit 2016. It provides information on registration fees for delegates, which are non-refundable but allow a change in nomination. Early bird discounts of 30%, 20%, and 15% are offered for registration before certain dates. Contact information is provided for two coordinators to register delegates by electronic transfer, cheque, or DD.
Delegate Registration Form
- 1. Yes, I would like to register for the INDIA INVESTMENT & INNOVATION SUMMIT 2016 Name : ____________________________________ Designation : ___________________________ Company/Organization: ______________________________________________________________ Address : _________________________________________________________________________ _________________________________________________________________________________ Tel: ________________________________________ Fax: _________________________________ Email: ______________________________________ Website: ______________________________ Also register our following colleagues:- 1. Name: ______________________________ Designation: ____________________________ 2. Name: ______________________________ Designation: ____________________________ 3. Name: ______________________________ Designation: ____________________________ 4. Name: ______________________________ Designation: ____________________________ 5. Name: ______________________________ Designation: ____________________________ Signature __________________________________ Company Seal : _________________________ For Delegate Registration, Please Contact: - Please Note, Delegate Registration Fee is Non-Refundable while Change in Nomination is Acceptable. DELEGATE REGISTRATION NON - RESIDENTIAL* `. 15,000/- / US$ 400 `. 42,000/- / US$ 900 `. 6,000/- / US$ 250 for One Delegate for Three Delegates Addl. Each Delegates `. 28,500/- / US$ 700 for Two Delegates `. 54,000/- / US$ 1000 for Four Delegates `. 20,000/- / US$ 600 Spot Registration DELEGATE REGISTRATION FORM 30% Early Bird Discount on Delegate Registration Fee before 30th September 2016. * Non-Residential is exclusive of Stay & Travel Theme : Payment Options : - - For Electronic Transfer / TT / NEFT / RTGS / OR Through Cheque / DD drawn in favour of Fortune Media Group Vignesh Nadar - Asst. Manager | Mobile : +91 - 91671 34994 | Email : conferencecell@fortunemediagroup.in Diana Suhanya - Coordinator | Mobile : +91 - 98201 25207 | Email : fmg@fortunemediagroup.in FORTUNE MEDIA GROUP, G002, Aabiel Paradise, Near DMart, Opp. Span Duplex, Bhayender (W), Mumbai, Maharashtra 401101, INDIA. Tel : +91 22 6565 7781 / 6565 7782 | Fax : +91 22 2811 8984 | Email : info@fortunemediagroup.in | Website : www.fortunemediagroup.in 20% Early Bird Discount on Delegate Registration Fee before 30th October 2016. 15% Additional Early Bird Discount on Delegate Registration Fee to the members of supporting industry association. 2016 value investors | financial services & innovations Economy Forecast, Outlook & Capital Growth 6 December 2016, Mumbai, India PARTICULARS OF THE BANK ACCOUNT Beneficiary Name Fortune Media Group Beneficiary Bank CORPORATION BANK Address of the Bank Mira - Bhayandar Road Branch, Thane - 401 107, Maharashtra, India Beneficiary Current 077701601000608 Account Number (As per appearing on the cheque book) IFSC Code CORP0000777 (Used for RTGS, IMPS and NEFT transaction) SWIFT Code CORPINBB-777 MICR Code: 400017060 Bank Code CORPINBB BSR Code : 0350806 50% Early Bird Discount on Delegate Registration Fee before 30th August 2016.