Download Exhibition Form in Word
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EXHIBITOR DETAILS
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Name of Organization
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Address
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City
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State
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Postcode
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Country
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Email Address
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Phone No
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Website
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Fax No
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BADGE FOR
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Exhibitor Delegate
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LUNCH COUPONS FOR
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Exhibitor Representative
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Sponsorship Tariff Rates(Please tick appropriate category.)
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SI No.
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Category
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Amount In Indian Rupees
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Amount In US$
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Platinum Sponsorship
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20,00,000/-
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44,000
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Diamond Sponsorship
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15,00,000/-
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33,000
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Gold Sponsorship
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10,00,000/-
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22,000
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Silver Sponsorship
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5,00,000/-
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11,000
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STALL NUMBER PREFERENCE
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Name of organization as to appear on Fascia
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Name
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Brief Product profile on Display
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MODE OF PAYMENT
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Mode of payment
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1. By cheque / demand draft
Demand Draft / Cheque drawn in favour of ASSICON 2012 payable at
New Delhi
Please send duly filled registration forms along with DD/Cheque to:
Conference Secretariat, ASSICON- 2012
C/o Indian Spinal Injuries Centre
Sector-C, Vasant Kunj-110070
New Delhi, India
Tel: 011-42255356, 42255243
2. By Wire Transfer:
Name of Bank: Corporation Bank
Address : Mata Chowk, Mahipalpur,New Delhi-110037
Account Number: SB01014672
Beneficiary: ASSICON 2012
RTGS/NEFT/IFSC Code : CORP0000624
MICR No. 110017049