Converge

Zone Name

Chapter Name

Name

Mobile Number

Email ID

Shirt Size

T-shirt Size

Room type (Please Note that Your room will be booked at Goa Marriott Resort & Spa, Miramar, Panaji)

Address1(Max. 100 Chars)

Address2(Max. 100 Chars)

State(Max. 50 Chars)

City(Max. 50 Chars)

Pincode(Max. 6 digits)

Do you have GST

Please note that the payment gateway does not accept AMEX cards and net banking of ICICI & HDFC banks.

Registration Form