Name :
Designation :
Company :
Address :
City :
Pin Code :
Phone :
Fax :
E-mail :
Course Fee to be paid by Draft only, drawn in favour of "Qmax Test Technologies Pvt. Ltd., Madras" for Indian Rupees Rs. 9,950.00
Draft No. :
Bank details :
Date :
However the Draft should be mailed by post and should reach the below address on or before 24th December 1998.
Qmax Test Technologies Pvt. Ltd., 27, 7th Avenue, Ashok Nagar, Madras 600 083. India.
Fill in, if accommodation is required :