Farmer's Dialogue 2014, India - Application Form for Indian Participants
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Title *
First Name *
Middle Name
Last Name *
Gender *
Date of Birth *
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YYYY
Address *
City *
Phone Number *
With Area Code
Mobile Number *
E-mail Address *
Occupation *
Sponsoring Organization
Date of Arrival *
MM
/
DD
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YYYY
Date of Departure *
MM
/
DD
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YYYY
Reference Person *
Meal Preference *
Bio / CV *
Expectations from Dialogue *
Would you like to make a presentation ? *
If yes, please give the description of the subject
Your Personal Contribution *
Program Contribution
For the entire Program (Akola & Panchgani) (4th to 10th Dec) : Rs.5000/- Per Person. (Cheque / Demand Draft to be drawn in favor of " Comptroller Dr.PDKV Akola")

For Program at Akola (4th to 7th Dec) : Rs.2000/- Per Person (Cheque / Demand Draft to be drawn in favor of " Comptroller Dr.PDKV Akola")

For Program at Panchgani (8th & 10th Dec) : Rs. 2000/- Per Person. (Cheque / Demand Draft to be drawn in favor of " Friends of Moral Re-Armament, India")
How would you like to contribute. *
All Cheques / Demand Draft to be drawn in favor of " Friends of Moral Re-Armament, India"
Bank Transfer details are as below :
Name of the Account Friends of Moral Re-Armament (India)
Name of the Bank         IDBI Bank
Name of the Branch Panchgani Branch
Address of the Branch  Shopping Complex, Main Road
                              Panchgani - 412805
                              Dist. Satara, Maharashtra
Account No.              47710010000372
Account Type              Savings Bank Account
IFSC Code of the Bank  IBKL0000477
MICR Code 700259477
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