Name : -------------------------------------------------------------------------------
Designation : --------------------------------------------------------------------------------
Address : --------------------------------------------------------------------------------
---------------------------------------------------------------------------------
----------------------------------------------------------------------------------
---------------------------------------------------------------------------------
Email address : ----------------------------------------------------------------------------------
Phone No (STD code) : ------------------------------------------------------
Veg. or Non-Veg. : ------------------------------------------------------
Hands-on or Trainee Delegate : -------------------------------------------
Accommodation
Single or Double : -------------------------------------------
A/C or Non A/C : --------------------------------------------
Date : From ----------------------------- To --------------------------------------
Hotel Name : ---------------------------------------------------------------------
Herewith enclosed a DD/cheque in favour of "FACE 2003" payable at Trichur. (Add Rs 50/- for outstation Cheque.)
DD/Cheque No : -------------------------------------------------------------------
Bank : --------------------------------------------------------------------
Registration Fee : -------------------------------------------
Advance Hotel Accommodation : -------------------------------------------
Total Amount : -------------------------------------------
Place:
Date:
Signature