REGISTER
Fields marked with * are mandatory
Your Name*

Your Email*

Designation*

Company*

Phone No.

Mobile No.*

Address*



Number of Delegate*

Amount*

Mode of Payment*

a) Cheque/D.D. No*

b) Cheque Date*

c) Bank Name*

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
Emily Boral
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: Emily Boral: emily.boral@exchange4media.com, +91 9967791877