Nomination Form
Si.
No
Details
Details
1 Name of the participant
2 Age
3 Qualifications
4 Department
5 Designation
6 Contact Details
7 Address
8 Email Id
Whether attending the program: “Self” / “Company nominated”.
[A] If Self:
I would like to attend the program on “The Power of Emotional Intelligence for
Heightened Awareness” scheduled on “06 th & 07 th May 2017”, in Chennai.
Signature_________________________________
[B] If Company nominated:
We would like to nominate our colleague(s) to attend the program on “The Power of
Emotional Intelligence for Heightened Awareness” scheduled on “06 th & 07 th May 2017”,
in Chennai.
Name, Designation:
Signature_________________________________
Bank details
NEFT/ Cheque / DD to be drawn in favor of “VED VYAS INNER SPACE”
Name of the Bank
Account No.
NEFT IFSC Code
Pan No.
Axis Bank, (Kilpauk branch, Chennai)
911020001602215
UTIB0000620
ACFPR6797N
All Inclusive Amount ₹.17,000/- (2 Days, Original Tools, Lunch & Snacks)
Contact: vedvyas.innerspace@gmail.com, shylahrd@gmail.com / 9677048048