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Asia-Africa Regional Conference: Virtual Registration Form

Your name, please

Phone Number

Email Address

Place of residence

From where will you be attending?

Are you an MDA Member?

Are you an MDA Member?
A
B

How will you be paying? (Please upload receipt below)

How will you be paying? (Please upload receipt below)

Please scan the QR to pay

MDA Member Rates: INR 5,000 for 1 day | INR 9,000 for 2-days Non-MDA Member Rates: INR 5,500 for 1 day | INR 10,000 for 2-days
https://storage.tally.so/5cfe596f-ec43-414f-a43a-a4df27b8477a/QR-Code-Maharashtra-Dyslexia_page-0001-copy.jpg
Please scan the QR to pay

Our Bank Details are as follows:

Bank Name: IDBI Bank

Branch: Sunny Estate II, Chembur, Mumbai

Account Name: Maharashtra Dyslexia Association

Account Number: 018104000075457

Account Type: Saving Account

IFSC Code: IBKL0000018

SWIFT Code: IBKLINBB004

MDA Member Rates: INR 5,000 for 1 day | INR 9,000 for 2-days Non-MDA Member Rates: INR 5,500 for 1 day | INR 10,000 for 2-days
Our Bank Details are as follows: Bank Name: IDBI BankBranch: Sunny Estate II, Chembur, MumbaiAccount Name: Maharashtra Dyslexia AssociationAccount Number: 018104000075457Account Type: Saving AccountIFSC Code: IBKL0000018SWIFT Code: IBKLINBB004

Please upload payment screenshot [Max. Size: 2 MB]