Online registration

Name :
LUGI Membership No:
Address :
Mobile No :
Email :

I would like to confirm my participation in the 15th Annual Convention of LUGI to be held at Hyderabad between 05th & 07th October, 2017.

I understand that the total costs of Convention are as per details given in the Circular Communication No.: 001 / 2017- 2018 dated 11.05.2017.

Plan opted :

Accommodation : YesNo

As per my opted plan my total registration fee is as follows: Rs. _________

Code No.: Agency (or) CLIA
Dev Officer (or) SBA …………………………………

Insurer:

Name of the Branch :

Name of the Division / Region:

Mode of Payment :

I have attached the following:

Photocopy of cash Direct DepositChallanCheque / DDUTR Number / Bank Transfer detailCopy of Credit / Debit swiping slip

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