Registration Form : EG 2007

Registration details for Butterfly India Meet-2007

1. Name:

2. Age:

3. Gender:

4. Traveling details of the participants:

§ Date of arrival at Rajahmundry

§ Is stay requirement at Rajahmundry: Yes/No

§ Details of stay requirement at Rajahmundry

o Number of persons

o Tariff range Low/Medium/High

(Charges of accommodation in Rajahmundry is not included in the registration charges)

5. Will you be presenting any paper/presentation/photo exhibition during the meet?

Yes/No

6. If yes, then mention topic for presentation:

7. Mode of payment: DD/MO

Amount to be paid Rs. 1,800/- in favour of Butterfly Conservation Society payable at Hyderabad

Enclosed is my remittance of Rs. ______ as registration fees for ­­­_______ number of participants by MO/DD number _____­__ dated __

Place:

Date: Signature

Contact details with phone number:

E-mail ID:

Send the above information filled in to USHODAYAN THAMPY with a copy to Vijay Barve