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The Institute of Cost and Management Accountants of

Bangladesh
ICMA Bhaban, Nilkhet, Dhaka-1205.

SAFA INTERNATIONAL CONFERENCE - 2013


To be held on October 10-11, 2013

REGISTRATION FORM
Name..........................................................................................................................
....................................................................
Membership
No.
(If,
ICMAB
Member).....................................................................................................................
.........
Designation................................................................................................................
.................................................................
Organization...............................................................................................................
................................................................
Contact
Address ......................................................................................................................
.................................................
...........................................................................................................
........................................................
...........................................................................................................
.........................................................
*

Name
of
Spouse
(Only
for
ICMAB
Member) ...........................................................................................
.....................
Phone
(Off)....................................................................................................
........................................

(Res) ..........................................................................................................................
................
Fax
...............................................................
mail: .............................................................................
Mode

of

payment

Cash

Cheque

Date ..............................................................
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No.

E-

.................................................
Tk. .................................

(.........................................................................
of .............................................................................
Bank, .......................................................... Branch (P.O./D.D./Cheque).

* Spouse allowed for valedictory session.

Signature : .............................
Date: .....................................
Last Date of Registration: October 7, 2013.

/var/www/apps/conversion/tmp/scratch_3/182931459.doc

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