Registration Form
*Are mandatory fields.
Personal Details
*
Full Name :
Address :
*
E-mail Id :
*
Area Code & Tel #
Mobile #
*
Designation :
Institutional Details:
*
Company Name :
* Office Address
*
E-mail Id :
*
Area Code & Tel #
* Date:
Payment Details
Early Bird Registration Before 20th January 2010 :
Rs. 6,000/- for one registration, Rs. 10,000/- for two joint registrations
Registration Fees (Inclusive of 10.3% tax) After 20th January 2010
For Industries: Rs 8,500/- for single registration or 13,000/- for two joint registration
For Academia : Rs .3,500/-
* Cheque / DD No.
* Amount
* Bank Name & Branch
* Date
++Accomodation Required ?
Yes
No
++ = Rs 1658/-(per day per person on twin sharing basis)
Cheques/DD should be drawn in favor of “Principal, Bhavan’s College, Andheri”
Please courier Registration form along with the cheque/DD to: Co-ordinator, Bhavan’s Research Center,
BarrackNo11.5/6, Near Post Office, Munshi Nagar, Andheri(W), Mumbai 400 058 , Tel (022) 65905947