CII School Education Excellence Mission to Singapore
May 11 - 15, 2015 : Singapore
REPLY FORM
(Use Separate forms for each delegate)
Dr. A Senthil Kumaran
Principal Counsellor - Education Excellence
CII IQ The K N Shenoy Centre
Confederation of Indian Industry,
Near Bharat Nagara II Stage,Viswaneedam Post, Magadi Road,
Bangalore 560 091, Karnataka, India
Tel: +91 80 23580315/ 2328 9391- 6085 Handphone : +91 9845390263
Email : a.senthil@cii.in
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I will be part of the CII NIEI School Leadership in the 21st Century
Executive Training Workshop for Indian School Leaders, Singapore
I am nominating CII NIEI School Leadership in the 21st Century
Executive Training Workshop for Indian School Leaders, Singapore
Name
1
2
3
1 Particulars
Full Name
Designation
Institution Name
Address
Telephone
Fax
Email
Please paste/scan
passport size
photograph
Designation
Institution
E-mail
Mobile
Website
Mobile or mobile
being used in
Singapore
Secretary Mobile No.
for India
Secretary Email
2
Passport Details
.
Passport No.:
Date of Issue :
Place of Issue :
Validity :
Required
Singapore Visa
Not Required
If you have a Valid Visa please give date of Validity………………………………..
Diet Preference
Vegetarian
Non - Vegetarian
3.
Specific Dietary Restrictions (if any)
__________________________________________________________________
4. Please attach bio-data of member/s (approx. 150 words) and the INSTITUTION profile (150
words in word document)) as given below (kindly send the same at the earliest by email):
PERSONAL PROFILE:
INSTITUTION PROFILE:
5. Hotel Accommodation
Please book the accommodation from _______________to ________________
Credit Card Details for blocking hotel accommodation. Members are requested to make the
payment directly with the hotel.
Name of the Card :
Validity :
Card Number:
CII would be suggesting a hotel, at concessional rates, for mission members to make
reservations directly.
6. Please indicate Flights from India/any other city to Singapore (can be sent nearer to date)
Note: Members are requested to make their own flight bookings and also to arrange for
airport/drop themselves.
WILL BE INFORMED LATER
Date
Arrival
Flight
From
To
Departure
Arrival
Departure
7. To cover the NIE program fee and administrative costs we are charging a nominal fee of Rs
60, 000/- (Inclusive of all taxes) per participant . The payment can be made by cheque/DD
in favour of Confederation of Indian Industry. Institute of Quality
Note: (This does not include group local transport, which will be shared by all members on
actuals)*
Details of Payment:
1. Cheque /DD No
2. Drawn on
3. Date
Signature:
Date:
Place:
*Pls Note: The participating members will be expected to cover their own travel and stay
cost (CII will work out special rates for travel and hotel stays and inform the members).