REGISTRATION FORM AICOG PATNA

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					 REGISTRATION FORM                                                                                                      AICOG 2014 PATNA




Name*

Designation*                                                            Institution / Affiliation*

Mailing Address*



City*                                   State                                       Country*                                   Pin*

Tel. No (O)                                        Tel. No. (R)                                         Mobile No.*

Email address*                                                                                             Fax No.

Accompanying Person (s) Name (Spouse, children over 12 years)

1                                                                                  2

Registration Fee*
                                 Category                                                     Early Bird Registration
                              FOGSI Member                                                             5500
                           NON FOGSI Member                                                            7000
                               PG Students                                                             3000
                           Accompanying Person                                                         4000
                               Banquet Fee                                                             1500
                             Foreign Delegate                                                          $ 250
                              Trade Delegate                                                           9000
* Mandatory field

Demand Draft

Registration form, completed in all respect along with the registration fee, may be sent to the conference secretariat. Registration payments should be
made through bank draft or cheques in favour of ‘AICOG 2014 PATNA” payable at Patna, Bihar.

I am enclosing herewith Demand Draft No..............................Dated..............................drawn on ………………………………………..…....................

bank, for Rs………………………...……….(in words,…….…………………………....……………….……….........................................………………...)




Date…………………………                                                                                                   Signature…………………………

                                                                  Conference Secretariat

                                                                    AICOG 2014 PATNA



                                                    Mr. Manish Kumar Mishra / Mr. Niranjan Kumar
               Thomas Cook (India) Ltd, Plot # 520, Udyog Vihar – Ph III, Gurgaon - 122016, P: +91 124 6120263 / 47 | F: +91 124 6120166

				
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