Program Registration Form - Indian Statistical Institute

Indian Statistical Institute, SQC & OR Unit, Bangalore
Certification Program
for
SIX SIGMA GREEN BELT (GB-08)
5 th , 6 th , 11 th , 12 th & 13 th November 2011
Registration Form
Organization :
`
Contact Person :
Mailing Address :
E-mail : Phone:
Fax : Mobile:
Details of the participants attending the program:
Name Position e-mail Mobile
1.
2.
3.
4.
Please provide a) Calculations (next page) for total amount payable, and b) Details (below)
DD attached Amount: Cash Receipt copy attached
(in favour of “Indian Statistical Institute” payable at Bangalore)
Amount:
DD No.:
Date:
Recpt. # :
Bank: Branch: Date :
Name : Signature :
Date :
P.T.O.

Calculation of Amount Payable:
-- 2 --
1
2
3
4
Participant
A. Sub Total of above
Whether Selfsponsored
/
Student
Whether
Staying in
Guest House
B. Group discount, if any (Nil otherwise)
C. Amt. after Group discount, if any (A - B ):
D. ADD: Service tax @ 10.3% (10.3% of (C) ):
E. Total Amount Payable (C+ D) :
Amount
Registration forms will not be accepted without DD for course fee
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***** Photo copy of this form may be used in case of more participants *****
Send completed form with fees and attachments to :
Program Director : GB-08
SQC & OR Unit
Indian Statistical Institute
8 th Mile, Mysore Road
Bangalore – 560 059, India.
E-mail: kspk1990@gmail.com
__________________________ ______________________________________
For Office Use