Gender Equity, Diversity and Inclusivity Seminar (GEDI)

June 14, 2009

Gender Resource Centre
Indian Institute of Management, Ahmedabad

REGISTRATION FORM
Last date for submission: May 15, 2009
A: PERSONAL DETAILS

1. Name
(Title) (First Name) (Middle name) (Surname)

2. Gender Male Female

3. Address

(City) (Country) (Pin/Zip code)

4. Telephone No. (O) (M) (H)

5. Fax No.

6. Email Alternate email

B: REGISTRATION DETAILS

C: PAYMENT DETAILS
Category
Payment
a) Registration Fee Rs/US$ Corporate Academia Govt.
NGO Other _________________________
(Please Specify)

Foreign Participant USD 72

Indian Participant Rs. 2,500

b) Accommodation
(fill only if applying for IMDC tariff
IIMA IMDC rooms) Rs/US$ Single room Rs 2800 per day (including meals)
Contact: Ms. Rasika Gaikwad
Tel: 079-6632 4426 email: gedi@iimahd.ernet.in

c) Accommodation charges for

accompanying person/s (if any) Rs/US$ Number of accompanying persons (if any)
One Two Three
Total Rs/US$
 C. Payment Details
Mode of Payment: Demand Draft in favour of Indian Institute of Management, Ahmedabad payable at Ahmedabad.
Please fill the following details regarding payment.

Amount Rs/US$ drawn in favour of

Demand draft No. dated

Branch

Please write your name and address on the back of the DD.

Section D: Traveling Details

Arrival Departure

Date

By Air/ Train

Flight/ Train Details

Time of

From/ To City of

Date:
Place: Participant’s Signature

Logistics

1. The registration fee includes kit, beverages and lunch during the seminar. It does
not include the cost of accommodation, local travel, and pre-/post-seminar tours.

2. The rooms for accommodation at IIMA are limited and will be allotted on first come
first basis.

3. In case of any change in your travel or stay plan, please communicate at the earliest.
If adjustments in booking of accommodation are required, they will be at the sole
discretion of IMDC.

Please fill the form completely and mail to

Prof. Asha Kaul
Wing 11-B, Indian Institute of Management, Vastrapur, Ahmedabad, Gujarat, India 380 015
Tel: +91-79-6632 4902 • (M) 98257 24481
Email: gedi@iimahd.ernet.in • Website: http://www.iimahd.ernet.in