1. 9th CONCLAVE ON INDIA- AFRICA PROJECT PARTNERSHIP
17 - 19 MARCH 2013: HOTEL TAJ PALACE, NEW DELHI
REGISTRATION FORM – AFRICAN DELEGATES
Please return this form by 10th February 2013
Ms. Devaki.K.N
Confederation of Indian Industry
The Mantosh Sondhi Centre
23, Institutional Area
Lodhi Road, New Delhi 110 003
Tel: 91-1124629994 / 24653092 Fax: 91-11-24601298 / 24626149
Email: devaki.k.n@cii.in / karanjit.singh@cii.in
Guidelines to filling up the application form:
 All persons registering are required to fill their details in ENGLISH ONLY.
 Kindly use BLOCK LETTERS to fill in the registration form. Please place
 Please return the file in WORD FORMAT. your
 Photograph: Please attach a scanned colour passport-sized photograph. photograph
The photograph will appear on the delegates booklet to help fellow participants to identify you. here.
First Name:
______________________________________________________________________
Last Name: ______________________________________________________________________
Designation / Rank / Position :______________________________________________________
Organization / Company Name :_____________________________________________________
Postal Address (incl. Zip/Pin code):_________________________________________________
________________________________________________________________________________
________________________________________________________________________________
Country:_________________________________________________________________________
Mobile number:___________________________________________________________________
Phone number:___________________________________________________________________
Fax number:_____________________________________________________________________
Email:___________________________________________________________________________
Website Address:_________________________________________________________________

2. COMPANY PROFILE: A Brief write up on your organization (Maximum of 200 words- BLOCK LETTERS) ENGLISH ONLY
SECTOR:__________________________________________________________________________________________
PROFILE:
PROJECT ON OFFER FOR THE 9th CONCLAVE
SECTOR:___________________________________________________________________________________________
PROJECT DETAILS (NOT MORE THAN 400 WORDS – BLOCK LETTERS) ENGLISH ONLY:
PROJECT SIZE: US$ _______________________________________________________________________________
I
Seeking a Partner for:________________________________________________________________________________
ARE YOU A MEMBER OF AN INDUSTRY ORGANISATION OF YOUR COUNTRY: YES NO
If Yes, Please give details : ___________________________________________________________________________

3. Please bring the detailed project for discussion during the 9th Conclave

4. Please bring the detailed project for discussion during the 9th Conclave

5. Please bring the detailed project for discussion during the 9th Conclave

6. Please bring the detailed project for discussion during the 9th Conclave