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Indian Institute of Management,

Ahmedabad EDUCATIONAL INSTITUTE

Please complete this form to apply for case/note access to our website.

University/Institute Name: ____________________________________________________

Email :____________________________________________________________________
(University/institute mail address is required)

Address Line 1: ____________________________________________________________

Address Line 2: ____________________________________________________________

Address Line 3: ____________________________________________________________

City : __________________________ State : ______________________________

Country : _________________________ Postal code: ___________________________

Website : _________________________________________________________________

URL : ___________________________________________________________________

Tel : _________________________ Fax : _________________________________

We nominate the following representative of the organization named above to act on our
behalf in correspondence with IIMA:
First Name : _____________________________________________________________

Last Name : _____________________________________________________________

Position/Designation: ________________________________________________________

Department : _____________________________________________________________

Email : __________________________________ Tel : ______________________

I agree to act as the IIMA representative for the university/institute named above.

_____________________
Signature of representative

Date: __________________

We publish e-bulletin, giving information of newly registered cases. Would you like to get our
“Case Information Bulletin” every month online? Yes No

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