14th National Conference of FIRA – Delegate Registration Form

14th National Conference of FIRA – Delegate Registration Form
IN COLLABORATION WITH Dakshina Kannada Vicharavadi Sangha and Aid Without Religion Trust

Date: 25,26 Jan 2027 (On 24 Jan a special program for local youths is scheduled but interested youth from other part also can register for it) Venue: Karnataka Bank Employees Association, Kapikad, Mangalore 575004 Contact: Vivek +91 9743290032 / Mayoor +91 9902258950 Delegation Fee: Rs. 1000/-
Personal Information
Full Name

First NameMiddle NameLast Name
Age
Gender

Other
Email
example@example.com
Mobile Number
Please enter a valid phone number.Format: 000 000 0000.
WhatsApp Number
Please enter a valid phone number.Format: 000 000 0000.
Postal Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Country
Professional and Organizational Details
Profession / Occupation
Organization / Association Name
Designation / Role
Organization Type
Conference Participation
Attendance Type
Would you like to present a paper at the conference?
Last date for paper submission: 15 November 2026
Selected authors will be informed by: 20 November 2026

Please send your papers to: dkvsmangalore@gmail.com
Interest in Participating in the Youth Meet scheduled on 24 Jan 2027
Food
Food Preference
Emergency Contact
Emergency Contact Name

First NameMiddle NameLast Name
Relationship
Emergency Contact Phone Number
Please enter a valid phone number.Format: 000 000 0000.
Payment Details

The registration fee is ₹1,000 per delegate and includes food, a delegate kit, badges and handouts. Registration is limited to 300 delegates.
Registrants can make the payment to the current account below:
Account #: 1169101032608
IFSC Code: CNRB0001169
Bank: Canara Bank
Branch: Car Street, Mangalore
Please upload your payment confirmation after payment is made.

Screenshot of the payment confirmation/state can you uploaded below
Payment Confirmation

PDF, JPG, JPEG, or PNG only.
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Final Confirmation
Additional requests
If accommodation is required, please contact +91 9743290032 / +91 9902258950 on WhatsApp for details of stays that delegates can book, including single rooms and dorms.
Should be Empty:

14th National Conference of FIRA – Delegate Registration Form

IN COLLABORATION WITH Dakshina Kannada Vicharavadi Sangha and Aid Without Religion Trust

Personal Information

Professional and Organizational Details

Conference Participation

Food

Emergency Contact

Payment Details

Final Confirmation