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Online Registration Form
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ONLINE REGISTRATION FORM
Low income countries
Online registration is possible only for delegates of National Societies
who are members of IPRAS
*Your membership status will be verified from the list provided by IPRAS
* Compulsory fields
Category *  
     
Name *
  Last name 
Initial
 First name 
Sex :
Mailing Address*  
City*
Postal code*
State *
Country*    
Institution*
E mail-1*
E mail-2
Telephones  
  Country code City code      
Number
Residence
Office*
Fax
Mobile

Passport Details (For foreign nationals only)
 
Number* Place of issue*
Date of issue* Date of Expiry*
Accompanying Persons
Number
Category    
Name     Relation
Passport Details  
Number Place of issue
Date of issue Date of Expiry
Payment Details ( fill amount in Rs.)  
Delegate * Accompanying Persons
Gala Party Accommodation Advance
Travel & Tour Master Class/HID
  Total Amount
   
Separate forms for Gala Party , Travel & Tours, Master Class & Accommodation need to be filled.

All money transfer cost toward 'Tour & Accommodation' will be borne by the delegate.
  I agree to accept the terms and conditions*


29th november - 3rd december 2009
hotel ashok, new delhi
 
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