Member registration Form

DELEGATE REGISTRATION FORM FOR MEMBER

Please tick the relevant category

Early Bird Discount phase II of Rs 1000 per delegate is valid till 10th November 2018.

 Name*Designation*Mobile No*Email*

*** Please click on left side check box before feeling the delegate information.

 

Nominated by:

Name

Designation

Membership ID *   (Contact Agijit Dasgupta at 8961214336 to validate**)

Organisation *

Organisation GST NO. *

Organisation PAN NO *

Organisation TAN NO *

Address/City/Pin *

Note:

  • Registration fee is non-refundable and non-adjustable with other CII events.
  • Pre-registration is mandatory. However, change in nomination is allowed.
  • ** Membership discount is applicable post validation.

# T & C Apply