IMC INDIA CALLING REGISTRATION FORM India Calling Conference Myanmar 24-26 November, 2013 All fees are quoted in Indian Rupees. Please complete one form per delegate. Delegate information First name: Last name: Position: Company / Organization: Address: Telephone (O): Telephone (R): Fax: Mobile E-mail Description of current business interest: Photograph of Self Please specify your interest for participation in India Calling: (Eg : If you are in Textile Business and interested in joint venture in readymade garments please mention Joint venture in readymade garments.) Choice of meal: Vegetarian Non-vegetarian Jain Accompanying spouse First name: Last name: Photograph of accompanying Spouse Choice of meal: Vegetarian Non-vegetarian Jain 1
Conference package (1) Registration fees: Category Registration Fees Delegate Rs. 30,000/- Accompanying spouse Rs. 20,000/- Net Amt (1): Rs. Registration fees are non-refundable Registration fees are inclusive of 12.36 % service tax (2) Conference charges: 2 nights and 3 days in Yangon, Myanmar: Hotel Chatrium Royal Lake Yangon 5 Star Hotel Name Single Occupancy Double Occupancy With spouse Chatrium Hotel Royal Lake Yangon Rs. 75,000 Rs. 1,35,000 The above charges include: Net Amt (2): Rs. Accommodation, Conference and charges as follows: 2 night accommodation (room only) inclusive of breakfast Hotel rooms will be allotted on first-come first-served basis according to availability. Any extra room services, telephone, mini bar, laundry & valet, and others not included in the package will be charged extra by the hotel and is payable directly to hotel by the participant 3 networking lunches and 2 networking cocktails/dinners, as per programme Transfers by AC coaches as per programme One-to-one meetings 2
Payment for Registration and Conference Package to IMC Registration charges should be paid immediately. Conference charges should be paid latest within 10 days of registration. By Cheque Cheque / Demand Draft of the following amount: Grand Total (1) + (2) Rs. By Cheque should be in favour of Indian Merchants Chamber Cheque No. Drawn on Bank Date By Credit Card (Please add 3 % service fee to the total amount, if paying by credit card) I hereby authorize Indian Merchants' Chamber to charge my Credit Card (2.5% extra will be charged as Bank Commission) for the following amount: Grand Total (1) + (2) Rs. in words towards the conference package for the India Calling. My credit card details are: Name of the card holder Date of birth Credit card No. Date of expiry (MM/YY) Visa Master Card CVV Code / Credit Card PIN code (final three digits on reverse side of the card) Signature of card holder Date By Bank Transfer Bank : Union Bank of India, V. N. Road Branch, Churchgate. Branch Code : 0290195; NEFT Code: UBIN0531952 Account No.: 319501010019046 When sending payment by bank transfer, please note that bank charges have to be paid by the transmitter. To enable us to identify your payment, please ensure that your name and India Calling appear on the bank transfer. 3
* Please indicate which Flight you are taking from the following: TG 318 23 Nov, 11:20 PM 24 Nov, 05:05 AM 4hr 15min TG 303 24 Nov, 08:00 AM 24 Nov, 08:45 AM 1hr 15min TG 302 26 Nov, 02:45 PM 26 Nov, 04:40 PM 1hr 25min TG 317 26 Nov, 06:55 PM 26 Nov, 10:00 PM 4hr 35min PG 734 24 Nov, 01:00 AM 24 Nov, 06:50 AM 4hr 20min PG 701 24 Nov, 08:50 AM 24 Nov, 09:40 AM 1hr 20min PG 704 26 Nov, 06:25 PM 26 Nov, 08:20 PM 1hr 25min PG 733 26 Nov, 09:15 PM 27 Nov, 00:20 AM 4hr 35min 4
Any Other Book at the earliest as flights and room are going full during that peak season of November. Cancellation Policy Registration fee non-refundable. Cancellation 30 days prior to the departure will get full refund of conference package. Cancellation between 30 to 7 days prior to departure date will get 50% of the conference package. No refund for cancellation done less than 7 days from the departure date. Please return the completed form along with the payment to: Ms. Kinjal Desai Assistant Director, Indian Merchants Chamber, IMC Building, Churchgate, Mumbai 400020 T:91 22 22046633 Ext: 624 ; Mob : 91 9867051117 Email : kinjal@imcnet.org Website: www.imcnet.org 5