Online/NEFT Payments Accepted, Details As Appended

Thursday, 17 November 2016: Hotel Hyatt, Pune Registration Form We are pleased to nominate the following participant (s) for the Conclave

S Name Designation E Mail Mobile Amount No. (Rs.)

5 Complimentary*

Total Amount Online/NEFT payments accepted, details as appended *For every four nominations one is complimentary (4+1) Nominated by:

Name : ………………………………………….. Membership No.: ……………………………………….

Organization : …………………………………..…….. E mail : …………………………………..…….

Designation : …………………………………………… Mobile : ………………………………………….. As reflect in the invoice : ** Filling the below blanks is mandatory

Organization : …………………………………..……..…………………………………..……..…………..…….…………..…….

Address 1 : …………………………………..…….. Address 2 : ……….……………………………………

City : ……………………………..………….. Pin: ………………… Tel: ……………………………………….

Category Per Delegate Registration Fee

CII, IGBC, IWN & YI Member (Large & Medium) INR 2500/- (inclusive of Taxes)

CII, IGBC, IWN & YI Member’s (SSI) INR 1500/- (inclusive of Taxes)

Non-Member INR 3000/- (inclusive of Taxes)

INSTRUCTIONS:  Delegate fee is inclusive of service tax.  The payment has to be made before the event incase you want invoice you may please put in the request to CII for invoice  Prior registration is essential.  Delegate fee once paid is non-refundable or adjustable in any other event ; however change in nomination(s) is acceptable  Membership No is to be mentioned. (if a member)  Programme is non residential Contact details:

Roshan Kumar | Confederation of Indian Industry (CII) | 10th Floor, Office D, Godrej Eternia-C, 'B' Wing, 3 Off, Pune-Mumbai Highway, Wakdewadi, Shivajinagar, Pune - 411005 T: + 91- 20 – 6607 5811, 5805 | [email protected] Payment details

The participation fee can be paid by way of DD/Cheque drawn in favour of ‘Confederation of Indian Industry’ payable at Pune.

NEFT payments accepted, details as below :

NEFT Details: Bank Transfer details: Confederation of Indian Industry; Bank Name: ICICI Bank;

Account No: 005705018006; ISFC Code: ICIC0000057; Branch: Ravindra NatyaMandir, Prabhadevi, Mumbai

Incase any help please Contact:

Mr Roshan Kumar Confederation of Indian Industry (CII) 10th Floor, Office D, Godrej Eternia-C, 'B' Wing, 3 Off, Pune-Mumbai Highway, Wakdewadi, Shivajinagar, Pune, - 411005 T: + 91- 20 – 6607 5811, 5805 E : [email protected]; [email protected] Mobile : 8975904800 (Roshan) Mobile : 9890882829 (Animesh)