Name of the firm:

Contact person with designation :

Address :

Tel :                                       Fax  :

E-mail :    URL :

We intend to participate in the corporate/commercial presentation , entitled :

Dates prefered for presentation

Representative details :-

Name :

Title :

Tel.(Res.) :                             Email:

We intend to participate in Exibition/Demostration, entitled :

Nos. of stalls required :

Contact person details

Name :

Title :

Tel.(Res.) :                              Email:

Other specific requirements :

Bank Cheque/DD No. : Amount Rs/US$:

Drawn on :

Dated :