INDIAN / OVERSEAS DELEGATE REGISTRATION FORM Name of the Delegat fuiss [os] br] Designation: MPEDA Acknowledgement number ( f available ): ‘Address (In capital letters): Pinizip code: State: Country: Mob: Tot: FAX: sinnnnneiuninen enna nies PMA category(v) [Farmer 1 others it others specity your tela PAYMENT DETAILS. We enclose cash or Bankers cheque / Demand Dratt No. dated for 2/08 ‘on, (Name of the Bank) favouring Aqua Aquaria India, payable at Emakulam, India being the delegate registration fee for one Indian / Overseas Delegate(s). WIRE TRANSFER DETAILS Name: ‘Aqua Aquaria India AICNe. 912020041 460939 IFSC Code: UTIBO001499 Bank: ‘Axis Bank Ltd, Panampilly Nagar Branch, Kochi, Kerala, India ‘switt AXISINBO8t Address: No. 27/704 ~A/a1/b/b1, G-282, Panampilly Nagar, Main Avenue, Dist - Ernakulam, Kochi - 682 036 E-mail: currentaccounts@axisbank.com Website: www.axisbank.com Important: Your name must appear in the Wire Transfer Information. All wire transfer fees are the responsibilty of the Delegate. | We have read the terms and conaitions given overleaf and agree to abide. Place: Signature of Authorized person Date: Name. ‘Terms & Conditions overteat‘Aqua Aquaria India 2015 will be held from 20 - 22 February 2018 at Vijayawada, Andhra Pradesh ‘The Registration fee for Indian / Overseas Delegates: ‘Type Fee Indian Delegate & 2000 Overseas Delegate us $75 PLEASE NOTE: REGISTRATION CAN BE SECURED ONLY BY MAKING PAYMENT For further details contact: + 91 484 2321722, 2912812 Fax: +81 484 2812812 E-mall;pubmpeda@gmall.com Terms and Conditions 1. Tho registration as an indian/overseas delegate enables you to enter the fair ground on all fair days, attend all the technical sessions arranged by the organizers. Fee once paid wil not be refunded. Lunch will be provided to the delegates on show days on production of specific coupons supplied to them. ‘Wire transfer fees wil be borne by the delegate. Registration and badge issue starts at 10 AM on 19th February 2015 at the venue shall adhere to the terms and conditions available in the website ww.aquaaquaria.com, 2 3. 4“ 5 8 Oe 7. Delegate registration is generally non-transferable. {8 Jurisdiction in any case of dispute will be Ernakulam , India 8. Use muttipe forms to register more delegates. 10. The show hours shall be from 10.00 am to 8.00 pm on 20" and 21" February 2015 and from 10.00 am to 6 pm on 22 February 2015, Please complete this form and return by fax or mail to: THE DEPUTY DIRECTOR (P&MP) THE MARINE PRODUCTS EXPORT DEVELOPMENT AUTHORITY (Ministry of Commerce & Industry, Government of India) MPEDA House, PB.No.4272, Panamplly Nagar, Kochi - 682 086, Kerala, india Phone: 491 484 2321722,2312612, 2311979 Fax: +91 484 2312812, 2319361, 2014467 E-mail: pubmpeda@gmal.com Please visit our website: www.aquaaquaria.com