The Western India Regional Council

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EVENT REGISTRATION - COMMON ENROLMENT FORM

* Indicates Mandatory Fields

Name : Mr./Ms. *

Mem / BB no. *

Address *

Phone (O)

Phone (R)

Fax (R)

Fax (O)

Mobile / Pager

Email *

Cheque/DD no *

Date(mm/dd/yyyy) *

Bank *

Amount *

Enrolment For

M. no.

Programme *

I would like to subscribe for Membership Rs. 1000/- / contribute Voluntarily Rs.
to "C. A. Benevolent Fund"

All payments will be accepted by A/c Payee Cheque or Demand Draft Only
	Enrolment forms along with cheque drawn in favour of "WIRC" should be forwarded to
	a)	WIRC Office, 5th Floor, Anveshak, Cuffe Parade or
	b)	WIRC Library, 580, Aayakar Bhavan, Mumbai 400 020 or
	a)	Extension Counter at RVG Hostel, Andheri(W), Mumbai 400 058.
	Names of co-ordinators are given in the Newsletter for telephonic clarifications, if required.
	You may also contact on 22187985 or 39893989 (Extn. 923) for clarifications.
	Please mention M.No. / B.B. No. on the reverse of the cheque / draft.

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