International Conference and Exhibition on Reinforced Plastics
10th to 12th January 2017, Bombay Exhibition Centre, Goregaon (East), Mumbai – India
Conference Delegate Registration Form (Indian)
Contact Details Title (Prof., Dr. Mr. Ms) as applicable: Name (as required to be printed): Company / University / Institution: Mailing Address:
City : State : Pin Code :
Tel : Fax : Mobile :
Email :
Website :
Registration Details
Category of Delegate (Please tick as applicable) Delegate Fees in Rs.*
General Delegate 4000 Existing member of FRP Institute Free** Become a new member of FRP Institute and get one free delegate pass for conference 5100** Student Delegate*** 1500
Note *Inclusive of 15% of service tax. **Online registration is must. ***Student delegate must enclose a certificate from the Head of Institution or from Head of Department
stating that he/she is a bonafide student Fill-up Separate Forms for Individuals from Same Organization
Registrations are non-transferable
Payment Details: (Tick Appropriate Box and Provide Details)
Payment is attached bank draft / at par Cheque in the name of “FRP Institute” payable at Chennai, India as per following details
Bank draft No.: Date: Bank:
Payment is done by Wire Transfer through bank, RTGS/NEFT details are :
Account Number : 10565622775
Name of the Account : FRP Institute
Name of the Bank : State Bank of India, SME Branch,
Guindy, Chennai – 600032
Swift Code : SBININBB227
Account Type : Current A/c Date : Signature :
Name : Designation :
This registration form along with payment may be sent to Dr.A.Selvam, Executive Secretary, FRP Institute,
NP 23/24, Developed Plot, Ekkattuthangal, Chennai – 600032, Phone: +91 44 42900325 Fax: +91 44 2225 0349 Mobile: +91 9841426644
Email: [email protected], [email protected] Website: www.icerpshow.com / www.frpinstitute.org
