DR MANIBHAI DESAI MANAGEMENT TRAINING CENTRE
BAIF Bhavan, Dr. Manibhai Desai Nagar N. H. 4, Warje, Pune 411 052. Maharashtra Ph: 91-20-5231661, Fax: 91-20-5231662 E-mail: baif@vsnl.comMDMTC |
NOMINATION FORM
PROGRAM TITLE:__________________________________________________________________
PROGRAM NO.:____________________________________________________________________
Name Dr./Mr./ Ms.:____________________________________________________________________
Designation:______________________________________________________________
Organisation.: _______________________________________________________________________
Address for Correspondence.:__________________________________________________________
________________________________________________________________________
Phone/S:_____________________Fax:__________________E-mail:__________________
Program fees:_________________Residential:____________Non-residential:____________________
DD/Cheque No.:______________Date.:__________________Bank:____________________________
Educational background:_______________________________________________________________
Brief description of current responsiblities:________________________________________________ _________________________________________________________________________ _________________________________________________________________________
TRAVEL PLANS
1.Arrival at MDMTC:
Date:____________________________Mode of Travel:___________________________________
2. Departure from MDMTC:
Date:____________________________Mode of Travel:___________________________________
Signature:__________________________