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Confederation of Indian Industry REGISTRATION FORM

Conference on "Tamil Nadu@75 - Six Transformational Ideas"

02 March 2009: Hotel Park Sheraton: Chennai

We nominate the following person(s) from our organization:


Name Designation Mobile Email

1. ------------------------------ ------------------------------ --------------- -----------------------------------

2. ------------------------------ ------------------------------ --------------- -----------------------------------

3. ------------------------------ ------------------------------ --------------- -----------------------------------

4. ------------------------------ ------------------------------ --------------- -----------------------------------

5. ------------------------------ ------------------------------ --------------- -----------------------------------

Delegate Fee:

Educational Institutions : Rs 750/-

Micro, Small & Medium Enterprises : Rs 750/-

Large Corporates : Rs 1250/-

Non Members : Rs 1500/-

(International Participants can pay equivalent amount in US$)

Organisations can avail a 10% discount on delegate fees on nomination of 3 or more


participants.

Enclosed Cheque / Demand Draft payable at Chennai for Rs ______________________in


favour of “Confederation of Indian Industry”

Organisation details:

Name: ----------------------------------------------------------- Designation: ------------------------------------------

Organisation: -------------------------------------------------------------------------------------------------------------

Address: -------------------------------------------------------------------------------------------------------------------

City: ----------------------------- Pin: ------------------------------- Phone: ---------------------- Fax: --------------


Mobile --------------------------------- E-mail: --------------------------------------------------------------------------

Kindly send in your confirmations by e-mail, courier or fax:

Ms Shruthi L

Tamil Nadu State Office, Confederation of Indian Industry, SR HQ

98/1, Velachery Main Road, Guindy, Chennai – 600 032

Tel: 044 42 444 555 (ext 541), Fax: 044 42 444 510

Email: shruthi.l@cii.in

* Delegate fee is non-refundable, however change in nomination is acceptable

* Prior registration is essential

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