DISTANCE
LEARNING PROGRAMME
ISA
CERTIFIED INSTRUMENTATION & CONTROL PROFESSIONALS
Intent
To Participate Form
first
name middle name surname
_______________
________________ ______________________________
male
/ female date of birth date _____ month ______ year______________
name
of the college / organization: _________________________________
address
for correspondance: ______________________________________
______________________________________________________________
city/town
______________ pincode______
telephone:
residence ___________________ office ___________________
fax
_______________ email ___________________
Acamademic
Achiements, degree, diploma, and other details in brief
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
Industrial
experience in brief
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Do
You Require Us To Reserve Accomodation For The Workshop (4nights 5days)
Yes / No
Payment
Details: Payment To Be Made After Confirmation Of Admission.
Payment
Terms: Rs.10,000 lumpsum in advance or Rs.2,000 along wih
application and Rs.1,800 in five instalments
Note:
Office
and/or Residential Telephone, Fax number and/or E Mail is must
Please fill this form, photo copy and send the original to:
ISA
International, Maharashtra. Section, India Region
9/10, Sapna CH society, Sector 4,
Vashi, Navi Mumbai 400 703
Telefax:022-782 2446,
Telephone: 022-782 4053
Email:
isambkg@bom3.vsnl.net.in
Instrumentation
. Systems . Automation - For the Benefit of Mankind
