Registration Form

First Name
Middle Name
Last Name
Designation *
Organization *
Street Address *
City *
State/Province *
ZIP / Postal Code *
Country *
Phone *
Email Address *
Accommodation *
No. of days required for accommodation *
Registration Fee *
Total AmountTotal Amount
Upload Screenshot of your Payment *
No file chosen
.jpg .jpeg .png max size 200kb
Date *

Payment Methods

Payment by Bank Transfer

State of Bank India

Beneficiary: Haldia Brajalalchak Welfare Organization
Account No: 38316201018
Account Type: Current
IFSC: SBIN0009390
MICR Code: 721002004
Bank Name: State of Bank India
Bank Address: PO – Debhog, City Centre, Haldia, PIN – 721657, Purba Medinipur, West Bengal

CANARA BANK

Beneficiary: HSE Conference
Account No: 110077503182
Account Type: Saving
IFSC: CNRB0002938
Bank Name: Canara Bank
Bank Address: Sukanta Nagar, Haldia-721657, Purba Medinipur, West Bengal

Payment via Phone pe
Google Pay : + 91-8609460285

Phone pe / Google Pay