18th FIMMDA - PDAI Annual Conference 2017
Hotel: Hilton Sydney, Australia
REGISTRATION FORM
(Open to FIMMDA Members Only)

DELEGATE COST
(Total seats available-200)

Includes :
Stay
Conference
All the events
Early Bird Price :- Rs. 125,000 + Ser. Tax @ 9.00% or as may be prevailing at the time of payment
TOTAL Amount : Rs. 1,36,250/- till 20th February, 2017
Price after 20th February, 2017 Rs. 1,35,000 + Service tax @ 9.00% or as may be prevailing at the time of payment
TOTAL Amount : Rs.147,150/-

* Please Note:
  • Hotel Check in time is at 3 P.M. on 13/04/17 and check out 11 A.M. on 16/04/17.
  • There is no provision for early check and late checkout.
  • Delegate cost does not include travel tickets, VISA, insurance (travel + overseas stay) and airport transfers.
*Mandatory Field
Personal Details
Name as per passport *
Institution *
Designation *
Address for communication *
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
Institution
Designation
Postal Address
Meal Preference
Email Id
Phone Number
Emergency contact name
Emergency contact number
Identity
Date of birth
Passport Number
Passport Expiry(validity 17/oct/2017 or beyond)
Place of Issue
Issue Date
Payment
Payment Type
Cheque/Demand Draft No
Payment Date
Delegate Fees
Service Tax
TDS
Net Amount
Remarks