Nomination Form

11th National Conference on Safety, Health & Environment:

Issues, Strategies & Programmes – Indian Situation - Global Vision

5-7 April, 2006 at New Delhi

Name & Address of Sponsoring Organisation
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Signature...................................

Name :......................................

Designation: .............................
Tel : .......................................... Fax :.........................................
E-mail : ......................................................................................
Whether NSC member : Yes/No
If yes, Membership No.: ...........................................................  
Name(s) of the Delegate(s)
Designation
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Enclosed Demand Draft/Cheque No…………… Dated ……….. .....for Rs…………...

· If there are more delegates, use additional sheet.

·   Delegate fee should be drawn by “A/C Payee” Demand Draft/Cheque in favour of “National Safety Council”, payable at Mumbai.

·   Add bank clearance charges for outstation cheques as indicated in the Brochure.