• * Denotes Required Field
    * Note : Blank spaces and special characters (like !@#$%^&*,-) not allowed.
  • 21st GCA - Corporate Registration Form (Includes AGFA and 75 Yrs Celeb)


Organization Details
*Organization Name :
If other, Please Specify :
*Address :
*Country :
*City :
*PIN/ZIP Code :
GST No (Recipient/Members):
GST Holder Name :
*Your Name :
*Landline No. :
*Mobile No. :
*Email-ID : Proper format "name@something.com"
Attendee Details
*Enter Member ID :
For non-members, enter member id as 0

*Name :
*Actuarial Association :
*Membership Category :
Designation :
*Country :
*Nationality :
*Email-ID : Proper format "name@something.com"
*Mobile No. :
*Address Line 2 :
*Concurrent Session you would be attending, on priority :


*Professional CPD 6Hrs
*Technical CPD 6Hrs


Special Dietary Needs :
*Are you attending 75 years event (on 17th February 2020)?
*Are you attending AGFA 2020 (on 17th February 2020)??
*Day 1 Dinner (on 18th February 2020):
*Whether the member requires accommodation in Hotel Renaissance :

I will have an accompanying person for the AGFA event :
Payment Details
Total Registration Amount (Including 18.00% GST) :
*Please select Mode of Payment :