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First Name :
Middle Name :
Last Name :
Email Address :
Company Name :
Nationality :
Date of Birth :
Passport Number :
Passport date of issue: :
Passport expiry date: :
Passport place of issue: :
Food preference:  
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 Payment Details
Delegate registration fee :
 Payment Method

Please select the appropriate payment option to indicate your method of payment.

  Option 1. By Cheque / Demand Draft in favor of "ICIC- 2010"  payable at SBI, Durgapur

  Option 2. By Cheque / bankers draft - $ USD only (for out side India)- payable to  ICIC-2010

  Option 3 . Bank Transfer to ICIC-2010's account at SBI Bank: Details below
        SBI Bank A/C Name : ICIC-2010
        DSP Main Branch A/C No      : 30783713314  
        Durgapur- 713 203 IFSC Code : SBIN0000074
        W.B, India Swift Code: SBININBB337

  Option 4. At Registration Desk, CMERI, Durgapur, during 21- 22th January, 2010

 

 
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