XIth Biennial Global Conference online registration form

REGISTRANT DETAILS (AS IN PASSPORT)

First Name*

Middle Name:

Last/Family Name:*

Address (as in passport)*

City*

State*

Postal*

Country*

Gender*

Age

Phone Number*

Email*

Emergency Contact Name*

Emergency Phone & Address*

Associated Province Name:*

Associated Region*

PROVIDE PASSPORT DETAILS (ONLY IF YOU ARE NOT A RESIDENT OF USA)

Nationality*

Place Of Issue:

Date Of Issue:

Valid Until:

Passport No

FAMILY DETAILS (WHO WILL BE ACCOMPANYING YOU)

Spouse (Delegate):

Age

Gender

Child Name:

Age

Gender

Child Name:

Age

Gender

ITINERARY DETAILS

Already Have a Valid U.S. Visa:

Yes

Date Of Arrival

Time Of Arrrrival

Date Of Departure

Time Of Departure

Food Restrictions:

Veg

Non Veg

Allergies?

Yes

Allergic Food If Any

Address Of Stay in US:

REGISTRATION PACKAGES

**(for L2, M2, & N3 packages) If you would like to come aboard the cruise, please add $100 per person to the registration cost.

Packages*

Add cruise tickets ($100 per person). For L2, M2, N3 select additional passengers.

Mode Of Payment*

Total Amount: $

Includes 2% Service Charge...

Total Amount: $

The Bank Details for WMC Conference 2018 payment.

To avoid processing delays, please use the following routing instructions for incoming wire transfers:
For Domestic Wires	Wire Routing Transit Number (RTN/ABA) 121000248
For International	SWIFT/BIC code WFBIUS6S
Bank name	Wells Fargo Bank, N.A.
Bank address	420 Montgomery St.
City & State	San Francisco, CA 94104
Account Name	World Malayalee Council NJ province convention 2018
Account number	2457888630

Make Check Payable to: WMC convention 2018. Check Mailing Address: Shobha Jacob, PO Box 75, Little Falls, NJ 07424

Terms and Conditions

By registering for the Conference, intending to be legally bound, I understand that it is my sole responsibility to provide for the visa, safety, liability and medical insurance of everyone listed on this form and I hereby agree to release from liability and to fully indemnify and hold harmless The World Malayalee Council and the Biennial Conference Committee (including, but no limited to, its officers, directors and members) and the World Malayalee Council America Region. This waiver and release is for any and all liability, including, but not limited to, personal injuries (including death), costs, expenses, property losses or damages occasioned by, or arising in connection with, any activity related to any and all Conference Events. I voluntarily assume all risk and danger relating to the Conference, whether occurring prior to, during or after the event. I fully agree to comply by the local and Federal laws of the land.

For Check/Cash/Wire - The Registration is complete on receipt of payments. Wire payment instructions are sent to your registration e-mail.

Registration questions or issues email to : wmcconfregister@gmail.com
Contacts: Pinto Kannampally 001 (973) 337-7238 | Thangam 001 (908) 477-9895

Conditions*

Accept Terms and Conditions