Plot no.: P 6,7,8, Sec.

5, IMT Manesar,
Dist. Gurgaon (Haryana)- 122 050
Ph:- 0124-2640000; E mail:
mediation.iica@gmail.com

Registration Form
Full name of Participant
Postal Address
Tel. No.
E mail address
Profession
Firm/Company/Institutio
n
Academic Qualification
Registration Fee

Cheque /draft No. __________________ dated:___________

drawn on Bank: _____________________________________
at _______________________ or through online transfer to
Indian Institute of Corporate Affairs, Beneficiary Bank: Bank of
India, Electronics Niketan, CGO Complex, New Delhi-110003
(India); IFSC/RTGS:BKID 0006048; A/c. No.:6048 1021 000

How did you know about

this course

0007
IICA website
Media Advertisement
Bar Associations/ Professional Associations
University/ College
Lawctopus
Law Rato
Others:___________________________

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Please send in the filled in registration form to Dr. Vijay Kumar Singh Associate Professor &
Head, School of Corporate Law, Indian Institute of Corporate Affairs, Plot No. 6, 7, 8, Sector-5,
IMT Manesar, Gurgaon, Haryana 122050, Tel: 0124 - 2640088/ 2640099 / 9891500707 at the
address/ email address mentioned above with registration fees details. Please mention name
and phone numbers behind cheques/demand drafts.