REGISTRATION FORM
To,
TÜV Rheinland (India) Pvt. Ltd.
ISCON ATRIA - 1, 205, Second floor,
Opp. GEB Training Institute, Gotri Road,
Vadodara - 390 021. Gujarat, India
Phone No:. 0265-3048720 | Fax No: 0265-3048726
Mobile: 96876 32909
E-mail:rajeev.gautam@ind.tuv.com;
akshay.ma@ind.tuv.com;
bimal.maniyar@ind.tuv.com,
manisha.rana@ind.tuv.com
Dear Sir,
Training on” Potential Failure Mode & Effect Analysis – FMEA”
S ept emb e r 2 3 – 2 4, 2 01 5
Reg ent a C ent r al b y R o yal O rch id (fo rm e r n am e Hot el Pr ad h yum an Lo rd s),
Ka law ad R oa d, R aj ko t
T el. + 9 1 2 81 2 5 6 2 88 0 | F ax: +9 1 2 8 1 2 56 1 67 7
T iming : 8: 3 0 am to 6 : 00 p m
We are nominating the following personnel from our organization:
Name
Designation
1. ________________________________
_____________________________
2. ________________________________
_____________________________
3. ________________________________
_____________________________
Participation Fee: Rs. 6000/- + Tax per Participant. (In case of more than Three Participants from
one organization will charge 5500/- + Tax per Participant)
Please find enclosed our Local Chq / DD (for Outstation cos.) No: ____________ dated
_______________ for Rs. ______________ in favor of “TÜV Rheinland (India) Pvt. Ltd.” payable at
Bangalore towards the participation fee for attending the Program.
Signature: _____________________
Name: __________________________________ Designation: ____________________
Organization: ___________________________________________________________
Address: _______________________________________________________________
Telephone: _____________________________ Fax: __________________________
E-Mail No: _____________________________________________________________
*******
2012/07/16
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