Registration Form
Date : 27-28-29 September 2019, Udaipur
Contact Person : Dr Kunjan Acharya(Organizing Secretary)
Contact No. : +919352727209/9414047744
Email address *
Your Image(* Max 1MB) *
Required
Title *
Name *
Designation *
Date of Birth *
MM
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DD
/
YYYY
Organisation/University/Institution *
Category *
STD Code *
Office No. *
Residence
Mobile *
Address *
Name of Spouse (If Participating)
Is accommodation required ? *
(Accommodation on twin sharing basis)
Date of Arrival *
MM
/
DD
/
YYYY
Time *
Time
:
Date of Departure *
MM
/
DD
/
YYYY
Time *
Time
:
By *
Train/AIR/Taxi
Payment Details
Pay By NEFT Or DD in favour of "All India Media Educators Conference - Lok Samvad Sansthan" - Payable at Jaipur.

Bank Name : ICICI BANK
Account No. : 675801700777
IFSC Code : ICIC0006758
Address : Jawahar Nagar Branch, Jaipur

(Payment Details NEFT Transaction / DD no.)

Registration Fee
Media Professionals/Academicians/Social Media activists
Rs. 3000 (Without Accommodation)
Rs. 4500 (With Accommodation)

Media Educators / Teachers Faculty Members
Rs. 3000 (Without Accommodation)
Rs. 4500 (With Accommodation)

Delegates from the Corporate Sector
Rs.4500 (Without Accommodation)
Rs.6000 (With Accommodation)

Research Scholars / Students
Rs.2500 (Without Accommodation)
Rs.3500 (With Accommodation)

Retired Media Professionals
Rs.2000 (Without Accommodation)
Rs.3500 (With Accommodation)

Spouses
Rs.1500(Without Accommodation)
Rs.2500 (With Accommodation)

Transaction Details *
Like : Transaction ID | Transaction date | Transaction amount | Account Number | Etc.
Place *
(Kalyan Singh Kothari)
A copy of your responses will be emailed to the address you provided.
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