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 1

Delegate 2

Delegate 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 name HDFC Bank, Ashram Road
Account No
00691110000078
Branch Code
000069
IFSC / NEFT Code
HDFC0000069

For Registration, You are requested to send the duly filled registration
form to:
Regional
Mr.RohitOffice
Patel

The Associated Chambers of Commerce

and Industry of India, Regional Office,
+91 9099993463
608, Sakar-3, Opp.Old High Court, Nr. Income Tax,
Email:B/h. Navdeep, Ashram Road,
AHMEDABAD 380 014.
assocham.ahd1@assocham.com
PH : (079) 2754 1728 29 / 2754 1876 / FAX: (079) 3000 6352