Preliminary Registration Request Form
Name and date of the training program:
Name and address of sponsoring organisation/participant: {in block letters}
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Phone(s): ………………………………… Fax: …………………Mobile………………
Email: …………………………………………………Web:…………………………….
Personal details of nominee(s)/participants
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Please register me/our nomination for the above mentioned Program as above details. Enclosed is Draft / Cheque No……………………………dated..................................... of Bank ................................................... for Rs ........................................... towards registration fee, drawn in favor of INSA-India……………………………………..……
Name of sponsoring authority: .......................................... Designation......................
Date:………………………… Authorised Signatory .......................................
Please send this form by post / fax / email to:
INSA-India
5/1 Benson Cross Road, Benson Town, Bangalore – 560046
Tel: 080-23536633; 23536299
Email: insaind@airtelmail.in
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