ICSI CONVOCATION-2016 (Southern Region)
REGISTRATION FORM
The Joint Secretary (Membership)
The Institute of Company Secretaries of India
ICSI House, 22, Institutional Area
Lodi Road, New Delhi-110003
Dear Sir,
Please register Mr./Ms.______________________________________ as a member for
attending the ICSI Convocation-2016 (Southern Region) to be held on Saturday,
25th June, 2016 at 01.00 p.m. (Reporting Time) at Dwaraka Auditorium, Lions
Edifice Hall, D G Vaishnav College, No. 833, EVR Periyar Salai, Arumbakkam,
Chennai - 600106.
The particulars of the member are as under:1.
Name of the Member
(in Capital Letters)
2.
Residential Address
3.
Mobile No.-
E-Mail:
4.
Telephone Nos.
(including STD Code)
Fax No.
5.
ACS No.
CP No.
6.
Name(s) of Accompanying Family Members/Guests (Max 2 nos.)
(i)
Student Regn. No.
(ii)
Yours faithfully,
(Signature of the Member with Date)
Note: Please mention your E-Mail / Mobile Number in this form legibly