*uhhq %how 7udlqlqj · offering to help individuals or organizations build capability in lean and...
TRANSCRIPT
0 - 18 September, 2 0 - 26 September,
Dept. of Industrial & Systems Engineering , IIT Kharagpur. Email: [email protected];
Leadership Skills Development Program LEAN SIX SIGMA at IIT Kharagpur
Date: ____________
S.No. Name of Participant Designation Total Experience Educational Degree Need Accommodation?
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IIT Kharagpur (Industrial &Systems Engineering Department) and ASQ South Asia have developed a unique
offering to help individuals or organizations build capability in Lean and Six Sigma, which covers instruction,
learning, application and certification.
Individual Name/Company Name:
Home/ Office Address:
City:
State:
Pin Code:
Contact No:
E-mail id:
☐ Black Belt Training: INR 64,900 (55,000 + 18% GST)
Total No. of Participants: ………….
☐ Green Belt Training: INR 38,940 (33,000 + 18% GST)
Total No. of Participants: ………….
☐ Project Support (remote, 5 sessions *2 hours each)
INR47,200 ( 40,000 + 18% GST)
Total No. of Participants: …………
TOTAL: …INR………………………………………………
REGISTRATION FEES PAYMENT
INDIVIDUAL/PARTICIPANT INFORMATION
INDIVIDUAL/ORGANIZATION INFORMATION
PLEASE NOTE
Interested individual candidates
or organizations sponsoring
candidates may please send this
application along with
registration fees in the form of at
par cheque or DD in favour of :
“CEP-STC, IIT Kharagpur” payable
at Kharagpur, India.
Contact person: Dr. Jitesh
Thakkar Dept. of
Industrial & Systems Engineering
☐ Click this box, if the application is by an
individual, not sponsored by an organization
PLEASE NOTE
Interested individual candidates or organizations sponsoring candidates may please send this application along with registration fees in the form
of at par cheque or DD in advance, in favour of: “CEP-STC, IIT Kharagpur” payable at Kharagpur, India.
Registration fees may also be paid through wire transfer to: Authority holding the account: Dean, CE, IIT Kharagpur; Name of Account: CEP-STC; Bank Name: Syndicate Bank; Branch Name: SRIC, IIT Kharagpur 721302; Address: Dist. Paschim Medinipur, West Bengal; BRANCH MICR NO. 721025103; Account Type: SB; Account No. 95562200002955; IFSC Code: SYNB0009556; SWIFT Code: SYNBINBB120
Accommodation: Arrangements for single accommodation will be made at IITKGP Technology Guest House for those who need it. Approximate
expenses for boarding & lodging is Rs.2000 per day, to be directly paid to Guest House.
Contact Person IIT Kharagpur: Dr. Jitesh Thakkar
Dept. of Industrial & Systems Engineering, [email protected], +91 3222 281830
Contact Person ASQ South Asia: Mr. B.S. Rawat
ASQ South Asia, 325 DLF Tower B, Jasola District Centre, New Delhi – 110025
[email protected], +91 11 46783399
Individual/Authority Signature: ………….………