National Conference: Registration Form
Saturday and Sunday the 22nd & 23rd December, 2018 at Sector 12, HUDA City, Near SRS Mall, Faridabad (Haryana)
Name of Delegate *
Your answer
Designation
Your answer
Vikas Ratna / Vikas Mitra *
Region *
Select your Region
Prant *
Branch *
Your answer
Spouse Name
Your answer
Postal Address
Your answer
CITY *
Your answer
Mobile No. *
Your answer
Email address
Your answer
Travel Mode *
Required
Arrival Date *
MM
/
DD
/
YYYY
Arrival Time *
Time
:
Departure Date
MM
/
DD
/
YYYY
Departure Time
Time
:
Registration Details
Registration Fee for Single Delegate: Rs 1200; Couple Delegate: Rs 2000; Children (10 to 17) - Rs 800; Guests: Rs 1200; Driver/Attendant: Rs 1000; Dormitory Accommodation: Rs 300 per day per person; Hotel Room 3 persons sharing (per day): 3x700; Hotel Room 3 persons sharing (Deluxe) (per day): 3x1000; Late Fee (after 15 November): Rs 200 per person
Delegates *
Number of Children (10 to 17 yrs)
Your answer
Number of Children (Up to 10 yrs)
Your answer
Number of Drivers
Your answer
No. of Guests
Your answer
Total Number of Participants (including Children, Driver and Guests) *
Your answer
Registration Fee Payment
Please furnish complete details of Registration Fee paid and inform through WhatsApp on +91-9811121346
Mode of Payment *
Amount Paid / Payable (Rs) *
Your answer
Additional Payments Details
Your answer
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This form was created inside of Bharat Vikas Parishad.