ONE-DAY WORKSHOP ON
“HAZOP STUDY”
at
institute of industrial SAFETY management
SCO-33, 1st Floor, Gillco Valley,Sector -127, Chandigarh Road, Kharar,Mohali,
Punjab 140301
On
th
17 February, 2011
Conducted by:
REGISTRATION FORM
ONE-DAY WORKSHOP ON
“HAZOP STUDY”
(Please tick in the appropriate box)
We would like to register ourselves for above course
We will not be able to attend this program, but please keep us informed about future
program
Enclosed herewith D/D for Rs. ________________Dated_____________ Drawn on: _________
_____________Payable to institute of industrial SAFETY management at Mohali.
Contact Person: ________________________ Company: _______________________________
Address: ______________________________________________________________________
______________________________________________________________________________
Tel No: _________________Fax_________________ Email: _____________________________
Participant 1 Participant 2 Participant 3
Name ____________ _____________ ____________
Designation ____________ _____________ ____________
Department ____________ _____________ ____________
Qualification ____________ _____________ ____________
Phone ____________ _____________ ____________