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EXECUTIVE EDUCATION PROGRAMMES 2011 - 2012

NOMINATION FORM
(for short duration open programmes only)

Title of the Programme:

Name (in official records): Mr./Ms./Mrs.


PARTICIPANTS DETAILS

Designation: Experience:
Management Junior Middle Senior Top

Total no.years:

Address for Communication:

Phone:
Emails:

Mobile:

ORGANISATION DETAILS

Main area of responsibility:


HRM ORNAIGAILS Finance Others Engineering

General Management Production/Operation

Sales/Marketing Info systems

Organisation type:
PSU

Public co

Private co

State Govt NGO

Central Govt

Organisation Name:

Organisation Address:

Phone:

Fax:

E-mail:

SPONSOR DETAILS

Name:
Designation: Official Address: Phone: Fax: E-mail:

Accommodation:
JOINING INFORMATION
(If the programme is not compulsorily residential)

Required

Not Required

DD drawn on bank:

bearing No:

Favoring Indian Institute of Management Bangalore towards programme fee for Rs.

Fee Receipt in the name of,

Organisation

Self

How did you first hear about this Programme? Please Indicate the HR/Training Head to whom we should send future programme brochures:

Advertisement: Website: E-mail:

Newspaper,

Magazine

Name:

Designation: Address:

Others: (Please specify) Fax: E-mail: Date:

Phone:

Signature of the Participant Authority

Signature of the Sponsoring

empt from

payment of IT. Please do not deduct IT at source

IIMB is exempt from payment of IT. Kindly do not deduct IT at source. Duly completed nomination form/s may please be sent to: The Administrative Officer (EEP) Indian Institute of Management Bangalore, Bannerghatta Road, Bangalore- 560 076 Ph: 080- 26993264/ 3475/26993742 Fax: 080- 26584004 /26584050 Email: openpro@iimb.ernet.in OR edp@iimb.ernet.in Website: www.iimb.ernet.in

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