Personal
Details
Title
--
Mr. Mrs. Ms. Dr. Prof.
Family name *
First name *
Gender
Male
Female
Organization
*
Job Title
Role at
Conference *
-- Select
-- Delegate -
Indian Delegate -
Foreigner Speaker Observer NGO Spouse Media
Address 1 *
Address 2
City
Postal Code
Country *
-Select Country- Afghanistan Albania Algeria American Samoa
Andorra Angola Anguilla Antigua and
Barbuda Argentina Armenia Aruba Ascension
Island Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgiu Belize Benin Bermuda Bhutan Bolivia Bosnia Botswana Brazil British Virgin
Islands Brunei Bulgaria Burkina Faso
Burundi Cambodia Cameroon Canada Cape Verde
Islands Cayman Islands
Central
African Republic Chad Republic
Chile China Christmas
Island and Cocos Islands Colombia Comoros Congo Cook Islands
Costa Rica
Croatia Cyprus Czechoslovakia
Denmark Diego Garcia
Djibouti Dominica Dominican
Republic Ecuador Egypt El Salvador Equatorial
Guinea Estonia Ethiopia Falkland
Islands Faroe Islands
Fiji
Islands Finland France French Antilles
French
Guiana French
Polynesia Gabon Republic
Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guantanamo Bay
Guatemala
Guinea,
People's Rev.Republic Guinea-Bissau
Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Japan Jordan Kazakhstan Kenya Kiribati Korea-North Korea-South Kuwait Kyrgyzstan Latvia Lebanon Lesotho Liberia Libya Liechtenstein
Lithuania
Luxembourg
Macao Macedonia Madagascar Malawi Malaysia Maldives Mali Republic
Malta Marshall
Islands Mauritania Mauritius Mayotte Island
Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands
Antilles Nevis New Caledonia
New Zealand
Nicaragua
Niger
Republic Nigeria Niue Norfolk Island
Norway Oman" Pakistan Palau Panama Papua New
Guinea Paraguay Peru Philippines Poland Portugal Qatar Reunion Island
Romania Russian
Federation Rwanda Saint Kitts and
Nevis Saint
Lucia Saipan San Marino Sao Tome Saudi Arabia
Senegal
Republic Serbia Seychelles
Islands Sierra Leone
Singapore
Slovenia Solomon Islands
South
Africa Spain Sri Lanka St. Helena St. Pierre and
Miquelon St.
Vincent and the Grenadines Sudan Suriname Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tonga Islands
Trinidad and
Tobago Tunisia Turkey Turkmenistan Turks and
Caicos Islands Tuvalu Uganda Ukraine United Arab
Emirates United Kingdom
United
States Uruguay Uzbekistan Vanuatu Vatican City
Venezuela
Vietnam Wallis and
Futuna Islands Western Samoa
Yemen Zaire Zambia Zimbabwe
Telephone (country
code- city code- number) *
- -
Mobile (country
code- city code- number)
- -
Fax (country code- city code-
number)
- -
Email *
Amount
-
--Select One-- Indian Rupees
US $ Euro Sterling
Pound
Passport
number
Place of issue of
Passport
Date of issue of
Passport
Date of expiry of
Passport
Flight Details (
Arrival in Delhi)
Arrival Date
January February March April May June July August September October November December -
1 2
3 4 5
6 7 8
9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 - 2007
Flight Number
Arrival Time
Departure Date
January February March April May June July August September October November December -
1 2
3 4 5
6 7 8
9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 - 2007
Flight Number
Departure Time
Arrival in
Jaipur
Mode of Transport
----Select---- By Road By
Air
Mode of Conveyance
----Select---- Own Arrangement
Arrangement
by ITDC
Registration Payment Details
Mode of payment
---Select
One-- Not
applicable, I am a special invitee
Bank Draft
/ Banker's Cheque Credit Card Direct Bank
Transfer
DD / Banker's Cheque Number
Bank's name and branch
Amount (Currency -
Amount)
--Select
One-- Indian Rupees
US $ Euro Sterling
Pound
Download Credit Card Authorization
Form (.doc - MS Word) OR Download Credit Card Authorization
Form (.pdf - Acrobat)
Note:
All Demand Drafts / Banker's
Cheques must be drawn in favor of
Please allow 3 weeks for
outstation (out of Delhi) Cheques.
Bank Transfer details:
Undertaking
I certify that the information
provided herein this form is complete and
accurate to the best of my knowledge
I understand that all bookings
are subject to confirmation from
I have read and understood the
cancellation terms and conditions.
I agree to pay the
booking deposit, with this form and balance
payment as desired, by