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IoS2019 Registration Form

*Required

*

*

 Name 

Gender

*

Mobile No/ Phone No

*

Email Address

*

Contact Address

Organization/Affiliation

Designation

Registration Fee

Bank Details for Online Transfer

Account Name: ACTREC-IOS2019

Bank A/C Number: 3760804981

Bank Name: Central Bank of India, Kharghar Branch

IFSC Code: CBIN0284047

SWIFT Code: CBININBBMAV

Mode of Payment

*

Cheque/ D.D. No/ UTR No.: 

Dated

Amount

Note:

 Please upload the scanned image of Bank Acknowledgement/UTR Number as proof

Select File
Max File Size 30KB

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