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Association of Inner Wheel Clubs in India
12th Triennial Conference
29th, 30th and 31st January 2010
Varanasi
Registration form |
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Name ……………………………………
IWC of …………………………………
District No ……………………………
Address …………………………………
Telephone No …………………………………
Mobile No …………………………………
Fax No …………………………………
E-mail …………………………………
Post Held …………………………………
Voting Delegate …………………………………
Proxy Holder …………………………………
Others …………………………………
ACCOMPANYING DLEEGATES
Name ……………………………………………
Relation …………………………………………
Total Person ……………………………………
Total Amount. Rs.
Enclosed D.D. No …………………. dated ……………….. of Bank ……………
In favor of “Association of Inner Wheel Clubs in India-12th Triennial Conference” payable at Varanasi.
Date ……………… Signature
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| REGISTRATION FEES: |
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Rs. 1800.00 (up to 31st Oct. 2009)
Rs. 2100.00 (up to 30th Nov. 2009)
Rs. 2500.00 (up to 31st Dec. 2009) |
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| REGISTRATION FEES FOR ACCOMPANYING DELEGATES |
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Rs. 3000.00 (for three days i.e. 29th, 30th, and 31st Jan 2010)
Rs. 1200.00 (for 29th Jan 2010 only)
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| NO REGISTRATION AFTER 31st Dec 2009 & NO REGISTRATION AT THE SPOT |
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Cancellation: 50% of the Registration Fees will be refunded on receipt of written request for cancellation till 30th November 2009,
The Demand Draft alongwith duly filled Registration Form should be sent to Registration Chairman, |
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Mrs. Gyan Lata Gupta,
E-1, Doorbhash Nagar, Raebareli-229010 (U.P.), India
Ph. 0535-2703445, Mob. .9415953503 |
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Registration Form will be available on Association Web Site www.innerwheelindia.com
Xerox copy of the Registration Form is also acceptable. |
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