<p> Thursday, 17 November 2016: Hotel Hyatt, Pune Registration Form We are pleased to nominate the following participant (s) for the Conclave</p><p>S Name Designation E Mail Mobile Amount No. (Rs.)</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5 Complimentary*</p><p>Total Amount Online/NEFT payments accepted, details as appended *For every four nominations one is complimentary (4+1) Nominated by:</p><p>Name : ………………………………………….. Membership No.: ……………………………………….</p><p>Organization : …………………………………..…….. E mail : …………………………………..…….</p><p>Designation : …………………………………………… Mobile : ………………………………………….. As reflect in the invoice : ** Filling the below blanks is mandatory</p><p>Organization : …………………………………..……..…………………………………..……..…………..…….…………..…….</p><p>Address 1 : …………………………………..…….. Address 2 : ……….……………………………………</p><p>City : ……………………………..………….. Pin: ………………… Tel: ……………………………………….</p><p>Category Per Delegate Registration Fee</p><p>CII, IGBC, IWN & YI Member (Large & Medium) INR 2500/- (inclusive of Taxes)</p><p>CII, IGBC, IWN & YI Member’s (SSI) INR 1500/- (inclusive of Taxes)</p><p>Non-Member INR 3000/- (inclusive of Taxes)</p><p>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:</p><p>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</p><p>The participation fee can be paid by way of DD/Cheque drawn in favour of ‘Confederation of Indian Industry’ payable at Pune.</p><p>NEFT payments accepted, details as below : </p><p>NEFT Details: Bank Transfer details: Confederation of Indian Industry; Bank Name: ICICI Bank;</p><p>Account No: 005705018006; ISFC Code: ICIC0000057; Branch: Ravindra NatyaMandir, Prabhadevi, Mumbai</p><p>Incase any help please Contact:</p><p>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)</p>