19th FIMMDA - PDAI Annual Conference 2018
Hotel: Crowne Plaza, New York
REGISTRATION FORM
(Open to FIMMDA Members Only)

DELEGATE COST
(Total seats available-175)

Includes :
Stay
Conference
All the events

Does not include:
Travel Tickets
Visa
Insurance (comprehensive)
Airport transfers

Early Bird Price: Rs. 1, 74,000 + GST @ 5.00% (at present)
TOTAL Amount: Rs. 1, 82,700/- till 31st January, 2018
Price after 31st January, 2018: Rs. 1, 89,000+ GST @ 5.00% (at present)
TOTAL Amount Rs. 1, 98,450/-
Spouse Cost (For 1st 10 applications only): Rs 80,000 + GST ( Total Amount Rs 84,000)

*Mandatory Field
Personal Details
Name as per passport *
(Surname) (Given Name)
Gender *
Name to be printed on identity Badge *
IF you are the spouse of a delegate please mention name of the delegate
Institution *
Designation *
Office Address *
Residential Address *
Meal Preferences * Vegetarian Non-Vegetarian
Email ID *
Phone No * +
(Country code - Mobile Number)
Emergency Contact Name *
Emergency Contact Number * +
(Country code - Mobile Number)
Personal Details
Name
Identity Badge
IF you are the spouse of a delegate please mention name of the delegate
Institution
Designation
Office Address
Residential Address
Meal Preference
Email Id
Phone Number
Emergency contact name
Emergency contact number
Identity
Date of birth
Passport Number
Passport Expiry(Minimum Validity 03-Nov-2018 or beyond)
Place of Issue
Issue Date
Payment
Payment Type
Cheque/Demand Draft No
Payment Date
Delegate Fees
GST(Rs)
Institution GST No
InstitutionGST PAN No
TDS
Net Amount
Remarks