FORM A
REGISTRATION FORM
A. Participant
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( ) Mrs. ( ) Mr. (
) Dr. ( ) Prof. ( ) M/s
Family Name..................................................................................................
First name......................................................................................................
Mailing Address
Institution.......................................................................................................
Department....................................................................................................
Position..........................................................................................................
Street.............................................................................................................
City, Postal Code...........................................................................................
Country..........................................................................................................
Telephone......................................................................................................
FAX..............................................................................................................
E-mail............................................................................................................
B. Accompanying Persons
( ) Mrs. ( ) Mr. (
) Dr. ( ) Prof.
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For internal use only
FAMILY NAME.......................................................................................................................
FIRST NAME.............................................................................................................................
( ) Mrs. ( ) Mr. (
) Dr. ( ) Prof.
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FAMILY NAME.......................................................................................................................
FIRST NAME.............................................................................................................................
MEMBERSHIP STATUS & NUMBER
( ) IPS ( ) SAARC Countries
( ) Any Other
( ) BIPA/IAPA/AUIPA (
) Other Foreign
ACCOMPANYING PERSONS (Number)
Adult and children above 12 years................................................................................................
Children from 5-12 years..................................................................................................................
CHOICE OF FOOD
( ) Veg + ( ) Non-Veg
= ( ) Total
Tick if you request for
( ) Accommodation ( ) Sight Seeing
( ) Return Reservation
Arriving On
Date.............................................................
By Flight/Train No........................................................................................................
At..........................................AM/PM
Leaving On
Date.............................................................
By Flight/Train No........................................................................................................
At..........................................AM/PM
Details of Payment
For Registration Rs/ US $............................................................................................................
For Accommodation Rs/ US $......................................................................................................
For Sight Seeing Rs/US $............................................................................................................
For Return Ticket Rs/US $............................................................................................................
_________________________________________
TOTAL
In Words .........................................................................................................................................
Demand draft No.............................................Dated.....................................
Bank with Branch...........................................................................................
