ANNUAL INVESTITURE MEET - 2018 CHENNAI  On Saturday, 3rd February and Sunday, 4th February 2018

Personal Details:- All fields with * are mandatory.
Lodge No:*
Title:*
Name:*
Spouse Name:
Address
Mobile.No:*
*Enter 10 digit mobile number(do not prefix 91 or 'Zero') to which sms will be sent.
City:*
Tel(Off)
PIN Code
E-Mail:*
Travel Details : Please provide your travel details so as to make us neccessary transport arrangements.
Arrival On    
By
Flight No/ Train No/Other/Own  
Departure On  
By
Flight No/ Train No/Other/Own  
Accommodation Details: Note: Hotel booking can be done DIRECTLY / through travel websites. 
Hotel Name:  
Preferred Food: Medical Information :
Self
Veg  Non-Veg
Blood Group
Spouse
Veg Non-Veg
Name of drug(s) alergic to
    Do you have low / high BP
    Are you Diabetic
    In case of Emergency
Contact Person Name

    Number
Registration Details:
Registration:*
Registration Amount   
  
    Total
Payment Details:
* Please note that the Website does not provide Electronic Fund Transfer or Net Banking connectivity, You can Register online and forward your payment by Demand Draft/Cheque favouring "Regional Grand Lodge Of Southern India ".
Alternately you can NEFT or RTGS the amount and fill in the details. For account details
Hover over here Bank :CENTRAL BANK OF INDIA Branch: MOUNT ROAD BRANCH Account Name :REGIONAL GRAND LODGE OF SOUTHERN INDIA Account Number :Current A/C : 3430720857 IFS Code: CBIN0280879 (Fifth character from left to right is ZERO)
Cheque D D   Online Bank Transfer
Cheque/D.D No*: On Bank/Branch*
Transaction number:* Date*
    Amount*
     
Request: Please avoid cash deposits.
 
 
 
 
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