Energy Summit

Registration Form

Number of Delegates	Amount	Delegate Deliverables
Corporate Delegates - 7 Nos.	Rs.31,000/-	Summit Kit & Background Paper
Corporate Delegates - 5 Nos.	Rs.21,000/-	Breakfast, Lunch & Dinner
Per Delegate (Non-members)	Rs.6,000/-	Access to all the Sessions
Per Delegate (VIA Members)	Rs.5,000/-	of the Summit
(*Registration fees non refundable, However change in nomination is acceptable)

I/We are interested in participating in Energy Summit' 10

Name:		Designation:
Name:		Designation:
Name:		Designation:
Name:		Designation:
Name:		Designation:
Name:		Designation:
Name:		Designation:

Enclosed, please find our Cheque (at par)/DD bearing number dated drawn on for an amount of Rs. towards delegate fee for number of delegates as stated above.

VIA Member: Yes No

Name of the Organisation:
Address:
Telephone:
E-mail:

All Cheques (at par)/DD should be drawn in favor of Vidarbha Industries Association, Nagpur and Sent to below address.

or

Directly deposit in our Central Bank of India A/C No. 1308650012.
Central Bank of India [Xsicom Udyog Bhawan Extension Counter, Civil Lines, Nagpur - 440 001] Branch Code 10695 If the A/c is in another Bank the transaction is through RTGS.

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