We are nominating the following person(s) to attend the programme. Full Name 1. ________________________________ ___________________________________ 2. ________________________________ ___________________________________ 3.

________________________________ ___________________________________ 4. ________________________________ ___________________________________ The DD/Cheque No. ___________dated ________________ for Rs. __________ Designation

Name

__________________________________________________________ Designation :

__________________________________________________________ Organisation :

__________________________________________________________ Address :

__________________________________________________________ Pin Code :

__________________________________________________________ Tel :________________ : ________________________________ Mobile No ________________________________E-mail:

Fax : ____________________