Center for Executive Education
Nominee Registration Form

Please check the program you are nominating the delegates for :


       10-13 Jan, 2010 at Taj Deccan, Hyderabad, India
       27-31 Mar, 2010 at FABR, Goa, India
      Module I  : India, 7-11 Jun, 2010
      Module II : USA, 21-29 Jun, 2010

      6 - 10 Aug, 2010 at ICRISAT, Hyderabad, India
 10 - 14 Oct, 2010 at Taj Vivanta – Panaji, Goa, India
       17 - 21 Jan, 2011 in India

Organizational Details

Organization* :
Postal Address* :
City* : State* :  
Country* : Post Code* :  
Phone* : Fax* :  
Website* :

Billing Details       As above         

Organization Division or Unit :
Postal Address* :
City* : State* :  
Country* : Post Code* :  
Phone* : Fax* :  
Email* :

Nominee Particulars

Participant 1 (Compulsory)
Name (as on the passport)* :  
Designation* :  
Email id* :  
Desk Phone :   Mobile* :  

Participant 2 (Optional)
Name (as on the passport) :  
Designation :  
Email id :  
Desk Phone :   Mobile :  

Participant 3 (Optional)
Name (as on the passport) :  
Designation :  
Email id :  
Desk Phone :   Mobile :  

Participant 4 (Optional)
Name (as on the passport) :  
Designation :  
Email id :  
Desk Phone :   Mobile :  

Nominating Authority(Compulsory)

Name*  
Designation*  
Email id*  
Desk Phone*   Mobile*  

Remittance Particulars

         
Reference No :   Date :   (DD/MM/YYYY)
Drawee Bank :   Amount :  

  How did you find out about this program ?
                 Others (please specify)
  Briefly describe the learning’s that you would expect for your nominees through this program?
* fields are mandatory