INTERNATIONAL CONFERENCE

ON
SOCIO-ECONOMIC STATUS OF SENIOR CITIZENS-
PROBLEMS AND SOLUTION
March, 12-13; 2018

ACCOMMODATION FORM
(Please fill this form in Capital Letters)

Surname: ……………………………….. Name: …………………………………………..

Address: ………………………………………………

………………………………………………………
City: ………………………….. State…………………………. Country:…………………….

Mobile No: ……………………………. Email: ………………………….

Arrival Details: Train/ Flight No…………………… Arrival Date……………….Arrival Time………..

Departure Details: Train/ Flight No……………..Departure Date……………. Departure Time….

Need Room from Date………………… to date………………

Please book SGL/DBL room for me for…………… nights.
I knaw that the tariff is Rs. 1500/- per room per night on twin sharing basis. I shall pay for my
accommodation, as per the instruction received by the Guest House/ Hotel/Organising
Committee.

Place:
Date: SIGNATURE
______________________________________________________________________________

Note: Please send scanned copy of the filled in and signed form by email to icsencit@gmail.com as well
as to guptajr2005@gmail.com