Pre-Registration for SSA 2017
Event Timing: November 3-5th 2017
Event Address: Hotel Jehan Numa Palace, Bhopal
Contact us at gsbhopalhub@gmail.com
For detailed Itinerary of the SSA 2017 please visit: http://gsbhopal.org/ssa2017
Email address
Name
Your answer
Surname
Your answer
Gender
Please Enter your date of birth
MM
/
DD
/
YYYY
Which hub do you belong to?
Your answer
Share your globalshapers.org profile link
Your answer
Preferred email id
Your answer
Your contact Number
This number will be used to create WhatsApp group for SSA 2017
Your answer
Country of Residence
Do you need a visa to travel to India
Passport / Aadhaar Card No
Shapers from India can put in your Aadhaar Number.
Your answer
Please enter your passport date of issue
(This field is mandatory for people travelling from outside India and need visa)
MM
/
DD
/
YYYY
Please enter your passport date of expiry
(This field is mandatory for people travelling from outside India and need visa)
MM
/
DD
/
YYYY
Accommodation Preference
Why do you want to attend SSA 2017?
Please give in your answer in not more than 100 words
Your answer
I understand that I have to pay for my accommodation and travel for SSA 2017
Required
A copy of your responses will be emailed to the address you provided.
Please complete the captcha before submitting the form.
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms