Entry Form (all fields required)
Please read the page fully before filling up the form.
| Name of House Magazine | |||
| Name of Organis(z)ation | |||
| Address | |||
| City | Postal Code | ||
| Country | |||
| Phone | Fax | ||
| Name of Signatory | |||
| Designation | |||
| Cheque/Draft No: | Date | ||
| Bank Name | Payable at | ||
| Currency & Amount | |||
| No of issues of magazines submitted | (minimum 2 issues required) | ||
| Signature | |||
MAILING INSTRUCTIONS:
Please mail/courier a printout of this form (duly signed by the signatory) together with the issues of house magazines and entry fees (DD in favour of ROTARY CLUB OF COCHIN MIDTOWN),
to the following address:
Chairman, 14th House-Magazine Contest 2010,
B-204 Santhi Enclave, Ponneth Temple Road, Kadavanthra, Cochin 682020.
Tel: +91-484-2312386, +91-97457-36782
Email: hmc@rotary-cochinmidtown.org
© 2002-2009 Rotary Club of Cochin Midtown