Indian Statistical Institute, SQC & OR Unit, Bangalore Certification Program for

SIX SIGMA GREEN BELT (GB-08)

5th, 6th, 11th, 12th & 13th November 2011

Registration Form
Organization ` Contact Person : :

Mailing Address :

E-mail Fax

: :

Phone: Mobile:

Details of the participants attending the program: Name Position 1.

e-mail

Mobile

2.

3.

4.

Please provide a) Calculations (next page) for total amount payable, and b) Details (below) DD attached
DD No.: Bank:

Amount:
Date:

Cash Receipt copy attached

Amount: Recpt. # :

(in favour of Indian Statistical Institute payable at Bangalore)

Branch:

Date :

Name Date

: :

Signature

P.T.O.

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Calculation of Amount Payable:

Whether Selfsponsored / Student Whether Staying in Guest House

Participant 1 2 3 4
A. Sub Total of above B. Group discount, if any C. Amt. after Group discount, if any D. ADD: Service tax @ 10.3% E. Total Amount Payable

Amount

(Nil otherwise) (A - B ): (10.3% of (C) ):

(C+ D) :

Registration forms will not be accepted without DD for course fee

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***** Photo copy of this form may be used in case of more participants ***** Send completed form with fees and attachments to : Program Director : GB-08 SQC & OR Unit Indian Statistical Institute 8th Mile, Mysore Road Bangalore 560 059, India. E-mail: kspk1990@gmail.com

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For Office Use