1. Delegate Registration Form

  2. First Name: *
  4. Last Name: *
  6. Age: *
  8. Sex: *
  10. Address: *
  12. Zip/Postal Code: *
  14. Contact Telephone Number: *
  16. Mobile Number: 
  18. Email Address: 
  20. Professional Status: *

  23. Delegate Fee is Rs. 100/- and for students Rs. 50/- (on submission of proof of being a Bon a fide student).
  24. Payment can be made by Bank Transfer. (Details as follows: A/C Name: 'VIBGYOR Film Collective', Account Number: 0084053000043772, The South Indian Bank Ltd, Thrissur (Main Branch), IFSC Code: SIBL0000084.
  25. If paying by Bank Transfer please ensure to provide your name and mobile number at the bank.
  26. Delegate pass will be ready only 24hrs after payment of fee.