RGL East Meetings

Constitution

Region

Lodge Name Lodge Name (for GLI members)

APPLICATION No

Title

Name

Address

City

State

Mobile

Whatsapp (if different from Mobile)

REGISTRATION PARTICULARS

Registration

Registration Amount

SPOUSE DETAILS

Patrons and Donors are eligible for complimentary food coupons for their spouse.

Name

Mobile

TRAVEL

After selecting the date, click on the clock icon at the base to select the time

Arrival Date and Time

Arrival Mode

Arrival Description

Departure Date and Time

Departure Mode

Departure Description

Primary Choice of Hotel

Room Type

Extra Bed

No. of Days of Stay

Total Amount

Alternative Choice of Hotel 2

Alternative Choice of Hotel 3

In the event non availability of the primary choice, we will book your accomodation at the alternative hotels of your choice.

In the event non availability of all 3 choices, your accommodation will be confirmed at an alternative hotel.

Prefer Pick up from Hotel to Venue

FOOD PREFERENCE

Saturday

Mason

Spouse

EMERGENCY CONTACT

Contact Person Name

Contact Mobile No

SPECIAL INSTRUCTIONS

Any request / special medical condition to be aware of

REMITTANCE PARTICULARS

For delegates paying online; please select the name of the bank from which you have transfered the funds

Payment Type

Cheque No/Online Transaction No

Bank Name

Amount

INSTRUCTIONS

Cheque should be drawn in favor of LODGE NIPAL No.38 GLI

In case of payment by Cheque / Demand Draft, kindly mention your NAME and LODGE ID on the reverse of the Cheque / DD

In case of ONLINE TRANSFERS, please select the Bank Name from which you have made the transfer.

BANK DETAILS for online transfer are as follows : LODGE NIPAL No.38 GLI | Indian Bank, Civil Lines, Gorakhpur | Account No.: 2018 6676 204 | IFSC : IDIB000G611

REGISTRATION FORM