:::: Welcome to Alpcord Network ::::

ONLINE REGISTRATION / PAYMENTS
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 payments. 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 summit@alpcord.net / Alpcord@alpcord.com
Please complete this section carefully. The information you provide will allow us to correspond with you efficiently.
" Kindly fill up the form for registration , accommodation or tour arrangment as per the below " Please put the conference name in the required field."
Title	:
*Last Name	:
*First Name	:
*Nationality	:
Institution	:
*Address	:
*City	:
*Province/State	:
*Country	:
*Postcode	:
*Phone	:
Fax	:
*E-mail	:
Number of Accompanying Person (s) & Details	:
*Purpose of Payment	:	Please tick for payment applicable
		Conference-Registration Accommodation Travel Tour Misc

Convert the local currency into Indian National Rupee (INR) at prevailing rates.

CONFERENCE DETAILS :
* Conference's Name	:
* Conference's Date	:
Registration Amount	:	INR
ACCOMMODATION	:
Hotel Name	:
Period of stay	:	to
Total Amount	:	INR
TRAVEL & TOURS	:
Tour Amount	:	INR
Travel & Ticket Amount	:	INR
Transport Amount	:	INR
Airport Pickup	:	INR
MISCELLANEOUS	:
Misc Details	:
Misc Amount	:	INR
*Total Amount	:	INR
Payment Option	:	Visa
		American Express