fad 2015 interest form

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Registration Form

I / We would like to PARTICIPATE in the FAD 2015 on 4th August 2015.Name of Organization: ____________________________________________________________Address: __________________________________________

Tel No: ____________ Fax No: ______________ Email:___________________________________

Delegate 1Delegate 2Delegate 3

Name

Designation

Mobile

Email

Note: Pre-Registration is Must

Delegate Registration Fees:National : 500 INR + 14% service tax, International : 50 USD (Including S.T)All payments should be made by Demand Draft or Cheque in favor of ASSOCHAM Regional Office, Ahmedabad .Payment Details

Cheque/Demand Draft no. dateddrawn on ..................................amount

Rs. ........................... in favor of ASSOCHAM Regional Office, Ahmedabad .For NEFT / Direct Transfer

Bank and branch nameHDFC Bank, Ashram Road

Account No00691110000078

Branch Code000069

IFSC / NEFT CodeHDFC0000069

For Registration, You are requested to send the duly filled registration form to:Mr.Rohit Patel+91 9099993463Email:- [email protected]

Regional Office

The Associated Chambers of Commerce and Industry of India, Regional Office,608, Sakar-3, Opp.Old High Court, Nr. Income Tax,B/h. Navdeep, Ashram Road, AHMEDABAD 380 014.PH : (079)2754 1728 29 / 2754 1876 / FAX: (079) 3000 6352