INDIAN ASSOCIATION FOR PRODUCTIVITY, QUALITY & RELIABILITY
	( Affiliated to the International Statistical Institute ) Address: AD-276, Sector - I, Salt Lake City, Kolkata 700 064. Phone No.: 91-33-2334 6234/3 (12 Noon - 7 p.m.); Telefax: 91-33-2334 6234 Email: iapqr@yahoo.co.in

Registration Form

1. Event Name:

2. Participants Name:

3. Address:

a)Office b)Residence

4. Telephone No.	Office: ______________	Residence:_____________
	Mobile: ______________	Email ID:_____________

5. Fax No:

6. Organisation:

7. Designation and Department:

8. Qualifications:

9. Experience:

10. Food Habit:

Vegitarian / Non-Vegitarian

11. Membership Status:

Non-Member / Member / Nominee of a Collective Member

12.  Registration Fee of Rs. _______________ being paid in Cash or Bank Draft / Cheque (on a Calcutta Bank) Number _________________ drawn in favour of Indian Association for Productivity Quality & Reliability

11. Date : ________________

Signature

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