Hyderabad Randonneurs: Registration Payment details for BRM's 2017-18
The amount to be paid will be Rs750 for each  Brevet. Please pay accordingly and complete this form.
Please Note:  The medal fee has to be paid only after the ride is finished within the stipulated time and your brevet card stamped.

ICICI BANK ACCOUNT: “HYDERABAD RANDONNEURS”
SAVINGS Account#: 1804-01-000199
Branch: Financial District, Nanakramguda
IFSC CODE: ICIC0001804
MICR CODE: 500229059
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AIR Rider Number *
Please enter 4 letter Rider Number provided by AIR (e.g. 0010 or T012)
Your email ID *
Please enter your email id (given in AUDAXINDIA.org site).
Rider Name *
Please Enter Your Name
Phone Number (mobile) *
Please Enter Your Mobile Number for verification (if required)
Transaction Reference Number: *
Please enter TXN Reference Number APPEARING IN YOUR BANK STATEMENT.
Transaction Remarks *
Please provide the TXN Remarks entered while transferring money.
Date Paid *
Please mention the date amount was paid online.
MM
/
DD
/
YYYY
Amount Paid *
Please mention the total amount paid online.
brevet to which you have paid for *
Required
You MUST read the Participation T n C & Agree: http://tinyurl.com/nfou8b2 *
Please select your option.
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