TRAINING COURSE REGISTRATION FORM PUBLIC

EVENTS

Please send the completed form by E-mail to trainingindia@lrqa.com

Alternatively, call Ms. Priya at +91 22 42603425 / 426

1. Course details
Please refer to the Public Training Calendar as published on our
web-site (www.lrqaindia.com) for details of the course titles,
proposed dates and locations.
Course title Course Date
           
Course Location
     

2. Invoicing details
Name of the organisation / individual responsible for
payment, in whose name the invoice will be issued.
Name of Company Contact E-mail
           
Address for communication
     
Contact phone number Contact Fax
           
Contact Person Position
           

3. Delegate details
If different to above
Delegate 1 (Mr.)       E – mail      
Job Title       Phone number      

Delegate 2 (Mr.)       E – mail      

Job Title       Phone number      

Delegate 3 (Mr.)       E – mail      

Job Title       Phone number      

Delegate 4 (Mr.)       E – mail      

Job Title       Phone number      

4. Payment details
(Payment must be received 10 days before course commencement)
We are sending a payment of Rs.      , through a Cheque (payable at par at Mumbai), number      ,
dated      , drawn on       favouring Lloyd’s Register Quality Assurance Ltd.

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We agree to all the terms and conditions of this registration.

Signature: __________________________. Date:      

(*Signature is needed for all registrations except email registrations)

Delegate Places will be confirmed on receipt of course Fee in advance

All bookings are subject to our Terms and Conditions applicable to PUBLIC EVENTS

F/IND/03/04, rev 01, 31 May 2007 Page 2 of 1