GDW CONFERENCE REGISTRATION FORM

Indian Institute of Management Bangalore

July 25-27, 2007

Please note

*  Fields marked with an asterisk (*) are mandatory.

 

Section 1 – Personal Details

       1. Full Name*
       2. Title/Position*
       3. Organization/Affiliation*
       4. Mailing Address*
       4a. City*
       4b. Postal Code
       4c. Country*
       5. Telephone Number
       6. FAX
       7. Email Address*
         8. No. of accompanying person (s)
         8a. Country of Origin*
         8b. Date & Place of Birth*
         8c. Passport Number*

If you are from Afghanistan, Bangladesh, China, Pakistan, or Sri Lanka, please fill in the following details (if not, move to Section 2)

       A. Parentage
       B. Nationality
       C. Date and place of passport issue
       D. Permanent Address

Section 2 – Accommodation (the rate is per room/per night)

         9. Arrival Date
         10. Departure Date

          11. You can choose to stay at the conference venue. You'd be accommodated  at the Management Development Centre (MDC) at IIMB.  IIMB MDC is an air-conditioned complex on campus for IIMB guests.  

IIMB MDC Accommodation charges: US$100/ INR- 4500/(inclusive of breakfast)  

         Yes, I want accommodation at IIMB MDC

         No, I do NOT want accommodation at IIMB MDC.

Note: There is limited capacity at IIMB.  Hence accommodation at IIMB will be provided at first-come-first-server basis. If you want to stay in a hotel, please check out the links to various hotels in Accommodation section on the website.

Section 3 – Airport  pick up and drop

        Yes I want Airport Pick up

              Please choose a car of your choice.

                        Small car (Tata Indica)

                        Compact Car (Fork Ikon)

        No I dont want Airport Pick up

 

Section 4 – Optional Tours

         Bangalore Sightseeing (US$15/ INR 660/) – a half-day tour on 25th July, 2007.

         Mysore-Hassan Sightseeing (US$30/ INR 1452/) – a full-day tour on 27th July, 2007.

The quoted cost is based on the minimum number of participants. Most flights depart during the early evening. The tourists may need to stay another night at the hotel for the charge specified in Section 2.

Section 5 – Summary of Payments
         13. Section 1 – Conference registration fee(US$ 350; INR 15,400/INR 2500)* US$/ RUPEES
         14. Section 2 – Accompanying person/s (US$ 100/ INR 4400/) US$/ RUPEES
         15. Section 3 – Accommodation (to confirm accommodation at IIMB, one day's accommodation amount will need to be paid as part of the total payment (IIMB MDC/ day- US$100/ INR 4400) The accommodation amount for the rest of the days can be paid on arrival.  US$/ RUPEES
         16. Optional Tours(Refer Section 3)                           US$/ RUPEES
         17. Total payment (Reg Fees+ Accompanying persons + 1 days accommodation fee+ Optional tours.*          US$/ RUPEES
Payment method*

Enclosed is a bank draft in favour of “Indian Institute of management Bangalore” payable at Bangalore (drafted to a bank operating in Bangalore)

Bank Draft Details

Bank Name Branch Name
Date of Draft Draft Number
Place
Credit Card
Mastercard Visa  (We do not accept Amex Card)
Cardholder’s name
Today's Date*

*Note: If you decide to pay by Credit Card, Please download Credit Card Authorization form, by clicking this link. You can send the scanned copy of the completed and duly signed form as an email attachment to our Registration Office at this email address : gdw@iimb.ernet.in