DELEGATE REPLY FORM

4th International Health Insurance Summit 2010

"Health Insurance: Collaborating to build a foundation for Growth and Sustainability"
9-10 September 2010, The Grand, Vasant Kunj, New Delhi

Delegate Fee

Category Delegate Fees Per Delegate 4 or more delegates per organization

A CII Members Rs. 3000/- 25% discount on total amount

B Non CII Members Rs. 3500/- 25% discount on total amount

C Overseas $ 150 25% discount on total amount

D Students & Rs. 2000/- Group & Early Bird discount - N.A.
Research Scholars
*The Delegate fee includes 10.3% Service Tax
* Online Remittance facility available for overseas delegates

Early Bird Discount:

1. Early bird discount of 20% on registration received before 28 June 2010

2. Early bird discount for group (4 or more delegates per organization) 10% in addition to
group discount of 25% in the total amount, before 28 June 2010

Spot Registration charges Rs. 5000/- /$ 300 per delegate

Nominations:

S. No Name Designation E-mail Mobile

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The Cheque / Demand Draft No for Rs. __________ drawn in favour of

‘Confederation of Indian Industry’, payable at New Delhi is enclosed.

[Delegate Fee is non-refundable; however, changes in nomination are acceptable]

Organization: ___________________________________________________________

Address: _______________________________________________________________

CII Membership details: ____________________________________________________

Kindly send the completely filled Reply Form to:

Ms. Vaishali Srivastava
Confederation of India Industry
India Habitat Centre, Core 4A, 4th Floor, New Delhi
T: +91 11 4150 4514 - 19
Fax: +91 11 2468 2229 / 2468 2226
Email: vaishali.shrivastava@cii.in