I/We nominate following person(s) to participate in the conference. Please register accordingly: Name Designation E Mail Ph. No. Name Designation E Mail Ph. No. Organisation Name: ___________________________________________________________________________________________ Address: ________________________________________________________________________________________________________ City__________________________________Tel/Cell: _______________________________ Email: __________________________________ Please Select [ √ ]the Category of Registration: Registration fee includes access to conference venue, workshops and demonstrations, keynotes, lunches and refreshments during the conference days and the participation certificate. Payment instructions and registration form is available on the conference website: www.serd.org.in/bdab2016 REGISTRATION REMITTANCE Via Demand Draft/Cheque No.______________________________ Dated ___________________ Rs. ___________________ (Authorized Signatory) Fee is payable by DD/ Cheque in favour of ‘Society for Education and Research Development’ payable at New Delhi. Online Payment details Beneficiary Name : Society for Education and Research Development Account No. : 05291131002000 Bank Name : Oriental Bank of Commerce IFSC Code : ORBC0100529 (For Transfers from India) Swift Code : ORBCINBBIBD (For Transfers from Abroad) Delegates can pay by Credit Cards /Paypal account through link given on the website. Receipt will be generated by Paypal. Please inform us of the transaction details once payment is made/ DD & Registration Form is dispatched. Contact Details: Dr. Saurabh Mittal Conference Convener Mobile: +91 9818253275 [email protected], [email protected] www.serd.org.in/bdab2016