VCCircle Entrepreneur & Angel Investment
Forum: 2nd Edition
01 December, 2011, Mumbai
REGISTRATION FORM
Date of Registration: - ---/---/---
Standard Fees: -
For Entrepreneur/ Companies/ Start-Ups are INR 6000 + Service Tax (10.3%)
For others Like Investors/ I-Bankers/Consultants etc are INR 9000 + Service Tax (10.3%)
Early Bird Discount: 20% discount till 15th November
For Entrepreneur/ Companies/ Start-Ups are INR 4800 + Service Tax (10.3%)
For others like Investors/ I-Bankers/ Consultants etc are INR 6400 + Service Tax (10.3%)
10% from 16th Nov till 22th Nov
For Entrepreneurs/ Start-Ups/ Companies is INR 5400 + Service Tax (10.3%) per attendee
For Others like Investors/ Bankers/ Consultants etc is INR 7200 + Service Tax (10.3%) per attendee
DELEGATE DETAILS:
Company Name
Address
Contact No: Fax No:
Delegate Name Email Id Designation HandPhone Number
PAYMENT DETAILS:
Kindly send DD/Cheque in favor of “Mosaic Media Ventures Pvt Ltd”, payable At Par.
Bank Name Branch Name Cheque/DD No. Amount
You can also directly deposit cash, submit cheque or transfer online to our ICICI Bank a/c:
Account name: Mosaic Media Ventures Pvt. Ltd.
Account no: 629705014337
Branch Name: Mayur Vihar - Phase 1
IFSC Code: ICIC0006297
PAN: AAECM9813A
Service Tax Code - AAECM9813AST001
_____________________
Name and Signature
Cheque/DD has to be sent to:
Mosaic Media Ventures Pvt Ltd
B128, First Floor, Sector-5, Noida-201301.
Phone: 0120-4171111 | Fax no: 0120-4171124
Contact Person: Sandeep/ Kanika
Email: register@vccircle.com
For more details visit us at: www.vccircle.com