All the delegates are requested to fill up the below mentioned form to send money
directly with a credit card ( VISA/ American Express Card ) using this system.
Please note the following instructions and the mandatory fields for the smooth processing
of the form, i.e.
1. Full name
2. Conference Name ( Kindly skip if it is individual booking
3. Date and Venue
4. email address
The field will receive only INR ( Indian Rupees ). Kindly use currency converter
or consult us for the exact amount to be filled.
On submission of form, you will be directed to ICICI/ American Express payment gateway,
where the credit card ( VISA/ American Express ) details to be filled to complete
the registration process. A Confirmation message will appear on the screen for successful
Delegates who wish to register without payments will only submit once. We will revert
to you at the email address mentioned in the form after we receive the form.
For any assistance please email us at firstname.lastname@example.org