PMMAO-2014

FILL UP FORM BELOW:

Fields marked with * are mandatory
Your Name*
Your Email*
Designation*
Company*
Phone No.
Mobile No.*
Address*
Number of Delegate*
Amount*
Mode of Payment*

Fee is as follows: One Delegate Rs. 5,000 5-10 Delegate 10% Discount 11-20 Delegate 15% Discount 21-50 Delegate 20% Discount More than 50 Delegate 25% Discount

Cheque/DD to be sent in favour of “Adsert Web Solutions Pvt Ltd” And send to Agnel DSouza 301, KAKAD BHAVAN, 3RD FLOOR, 11TH STREET, OPP. GALAXY CINEMA, BANDRA WEST, MUMBAI 400050 PH: (022) 66206000 Quote Your Name and Phone number on the back of the Cheque/DD For any queries related to Registration, contact: Agnel DSouza: agnel@exchange4media.com, +91 9870292834