2025
Name (in block letters): Dr./Mr./Ms./Mrs./Prof.
Gender
MaleFemale
Designation
Organisation
Address
Pin Code
State
Country
Phone: STD Code
Office Telephone
Residential Telephone
Mobile
E-mail
Kindly Indicate
DELNET memberProfessional Working in MaharashtraRes. Sch./LIS Students (Full Time from MH.)Res. Sch./LIS Students (Full Time from outside MH.)Retd. Professional (Non Working)Non member
Accommondation Required :
YesNo
Food Preference :
VegNon-veg
Accompanying Person:
If yes:
Name:
Relation:
Payment details :
I am enclosing DD/ Cheque No./NEFT
Dated
For Rupees
drawn on DELNET, New Delhi towards Participation Fee of Rs.
Participation Fee:
Accomodation charges for
days for person(s)
@ Rs. per day
Place :
Date :
