INDIAN HISTORY CONGRESS,                                                                    80 th Session,Kannur University,Kannur, Kerala ,28 th to 30 th December, 2019
DELEGATE REGISTRATION FORM
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Email *
DELEGATE REGISTRATION FORM
Name *
Membership Type *
Membership Receipt No *
Date of Receipt *
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Designation *
Institution Affiliated ( if any)
Gender *
Age(In Years) *
Address *
State *
PIN Code *
Mobile Phone *
Delegate FEE Details *
Dietary Preference *
Travel Details *
Date and Time of Arrival *
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YYYY
Time
:
Date and Time of Departure *
MM
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DD
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YYYY
Time
:
Note
IHC will not be able to provide accommodation for accompany family members. Such delegates can arrange accommodation for  them . (Our next circular will contain details of available hotels with tariff.)
 
Sections/Sessions in which you will participate *
Payment via SBI Collect
Payment will be accepted via SBI Collect till 26/12/2019 https://www.onlinesbi.com/sbicollect/icollecthome.htm?corpID=1259162
Payment via DD
payment via DD in the name of local treasurer payable at SBI Fort road branch, 670001, Kannur , with a covering letter mentioning your name mobile number, membership number and email id. payment via DD will be accepted only till 1st December 2019
Bank Ref Number/DU- Number(SBI Collect) *
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