FICCI CEOs MISSION

REGISTRATION FORM FOR CLEANTECH DELEGATION
1.

NAME

2.

DESIGNATION

________________________________________________________________

________________________________________________________________
3.

ORGANISATION

________________________________________________________________
4.

MAILING ADDRESS ________________________________________________________________
________________________________________________________________
_________________________________________________________________

TELEPHONE(S)
______________________________ 6.
FAX_____________________________________
5.

E Mail:_______________________________ MOBILE NO_______________________________________
7.

BUSINESS INTERESTS

________________________________________________________________________
________________________________________________________________________
8.

SPECIFIC BUSINESS INTEREST
WITH USA
________________________________________________________________________
_________________________________________________________________

9.

DELHI CONTACT
NAME

_________________________________________________________________

PHONE __________________
_______________________
10.
DELEGATION FEE*
________________________

MOBILE NO__________________________ FAX

CHQ/DD NO.____________________________ DATED

Please send the completed form to, FICCI, Federation House,1, Tansen Marg, New Delhi
110001 Phone: 011-23487421, Fax: 011-23320714, 23721504

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