Workshop Registration Form

Name:
DOB: Pick a date
Gender: Male Female
Affiliation:
Present Position:
Address For Correspondence:
E-mail ID:
Mobile :
Bank Details :
Name of the Bank :
Correct UTR/NEFT number :
Amount :
IFC code of the bank where NEFT was done:
Date of NEFT : Pick a date
Security Text:  
Registration Fee: INR 700.00 , Payable to HFDC [Sambalpur, Main Branch]
Account Number: 50100202443743 , IFSC - HDFC 0000369
NEFT the amount for workshop registration