High Powered Business Delegation to Vicenzaoro - January 2015

REGISTRATION PROFORMA

1. Name ______(Strictly as per Passport) 2. Designation ______

3. Organization______

4. Address ______

______

5. Phone: ______(Office) ______(Mobile)

6. Fax:______

7. Email: ______

8. Delegation Fee: INR 25,000 Only + Service tax @ 12.36%

The payment can be made by cheque/DD in favor of Federation of Indian Chambers of Commerce and Industry payable at Delhi

ChequeNo______Dated______Drawn on______

9. Company Write Up A .For administrative reasons and for preparing the delegate profiles, please attach your Company profile (not exceeding 100 words) (Please attach a separate sheet)

B. Nature and Type of business / industries you would like to visit and meet in Vicenzaro

Please send this completed form to

Ms. Surabhi Pant Assistant Director Federation of Indian Chambers of Commerce and Industry (FICCI), Krishnamai Building, Sir Pochkhanwala Road (Police Camp) Worli Mumbai 400030 022- 24968000; 91 9619119128; [email protected]