2 Month Postgraduate Certificate Program

BECOMING A HIGH IMPACT LEADER IN

ENGINEERING ORGANIZATION
22 February To 27 April, 2016

REGISTRATION FORM

CoPE/2016/Leadership/_____
___________
Serial No. (For office use)
GENERAL INFORMATION

Name

Designation:

Department

Organization/ University:
*PEC Reg. No. (if app) :
*NOTE:

PCATP Reg. No. (if app)

For PEC CPD credit point, please provide your valid PEC number.

Cell # :
Postal Address (for dispatch of Certificate):

Email

Source of Information (tick one):

Media

News Paper

Website

Email

SMS

Letter

Social

Other ___

Fee Structure:
Fee Per Participant

Rs. 29,000/-

10% Group Discount Available (3 Participants).

Payable Amount (Rs.)

Applicants Signature
w/ Date

Registration Procedure:
1.

Official Invitation, Workshop Brochure and Registration form can be

downloaded from the following link.
https://www.dropbox.com/sh/pszvsz46rtncfcq/AAAAGSr3qaIBpoCreZmlDHIja?
dl=1
Downloaded Registration Form may kindly be sent to CoPE Secretariat
(see contact details below) preferably by Wednesday, January 09,
2016 via surface mail, email or fax.

OR

Registration Form may also be filled/ submitted online via the following link:
1.

http://goo.gl/forms/ei1n0Agr4F

2. Please make payment by Cash, Pay order or Cross Cheque in favor of

Chairman Department of Civil Engineering, NED University of

Engineering & Technology.
3. Cheque and filled Registration form may kindly be send by By post to the
Department of Civil Engineering, NED University.
4. You will receive a confirmation Email after three days of receipt of Cheque.
5. For details/ queries regarding the registration/ workshop, please contact us:
Mr. Tahir Khan, Workshop Coordinator
OR
Prof. Rizwan U. Farooqui, Focal Person
Ph: +92-21- 99261261 ext. 2273, 2616
Fax: +92-21-99261255
Email: cope@neduet.edu.pk, civilcpd@neduet.edu.pk ,
tahirkhan5720@yahoo.com,
rizulhak@neduet.edu.pk

PAYMENT INFORMATION
Serial No.CoPE/2016/ Leadership /___________
Date:
Name

(For office use)

Mode of Payment

Cash

Direct Deposit

Cheque

Pay Order

Bank Draft

No.
\

Amount (In Words):

Amount (In Digits):

Receivers Signature
Signature

PAYMENT RECEIPT (Leadership,11 Jan - 17 Mar, 2016)

Acknowledged that an amount of PKR _______________________ has been received
_________________________

Depositors

_____________________ dated: ________________ in form of cash / direct deposit/ cheque pay

order/ bank draft.
Receivers Signature