Post on 24-Oct-2014
description
FFE Registration Form
Please Email us the details of people attending the conference
In case of Group bookings (multiple delegates) please �ll in separate forms giving individual details of delegates. A single cheque for total amount for the total number of delegates can be sent.
Delegate Fees for Service Provider Companies - Rs.7500/- Delegate Fees for Pharma Companies upto 3 delegates - Rs.6500/-
Prices are inclusive of Power Breakfast with Decision Makers, Networking Lunch and High Tea
For the invoice/bill generation – let us know the - Name of the Person, Company Name & Company Address
Cheques should be made in the name of “Knowledge Ventures” and couriered to :Mr.Arvind Nair, FFE 2012 Secretariat, B/205, Ahimsa Enclave, O� New Link Road, Chincholi, Malad West, Mumbai 400064.
First Name
Last Name
Gender
Company Name & Address
Pin
Telephone
Mobile
Designation / Title
Payment Mode
www.medicinman.net
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For further details Contact: Mr.Arvind Nair, FFE 2012 Conference Director Contact : +919870201422 / arvindnair@medicinman.net
Bank & Cheque No: Branch :
Amount : Dated :
Alternatively you can make an online payment to the account of Knowledge Ventures the details of the
same are as follows:
Account Name : Knowledge Ventures
Bank name : ICICI Bank
Current Account Number : 122105500002
IFSC CODE : ICIC0001221
Bank Address : ICICI Bank, Malad Link Road Branch, Shop No.6 & 7, Linkway Estate, Malad West, Mumbai 400064.
www.medicinman.net
FFE Registration Form
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