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Chemical Burns Management - Stopping Incidents from becoming Accidents Date : 27-02-2015, VENUE: Country Inn & Suites By Carlson, Goa, Panjim Registration Form Name of sponsoring authority: BALASUBRAMANIAN S M Name of Organisation : BRITACEL SILICONES LTD. Address : …………………………………………………………………………………………………………………………………… Office No. ………………………………Fax. No……………………………….. Cell. No………………………………………… Email id :……………………………………………………………………………. Name of Delegated MEDICAL OFFICER 1 Name Designation Cell No. Email id. SAFETY OFFICER 2 Name Designation Cell No. Email id. PRODUCTION / LAB HEAD 3 Name Designation Cell No. Email id. Kindly note that there is no registration fees for the Seminar. However, since seats are limited, registration will be strictly on “first come first served basis”.

Chemical Burns Management

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Chemical Burns Management - StoppingIncidents from becoming AccidentsDate : 27-02-2015, VENUE: Country Inn &Suites By Carlson, Goa, Panim!egistration "ormName of sponsoring authority: BALASUBRAMANIAN S MName of Organisation : BRITACEL SILICONES LTDA!!ress : """"""""""""""""""""""""""""""""""""""""""""""""""O#$e No """"""""""""%a& No"""""""""""" Ce'' No""""""""""""""""Emai' i! :"""""""""""""""""""""""""""""Name of De'egate!M#$ICA% &""IC#!1 NameDesignationCe'' NoEmai' i!SA"#'( &""IC#!2 NameDesignationCe'' NoEmai' i!P!&$)C'I&* + %AB ,#A$3 NameDesignationCe'' NoEmai' i!(in!'y note that there is no registration fees for the Seminar )o*e+er, sin$e seats are 'imite!,registration *i'' -e stri$t'y on ./rst $ome /rst ser+e! -asis0-# !#.)#S' #/#!( C&MPA*( '& S#*$ !#P!#S#*'A'I/#S BAS#$ &* ',# 0 C!I'#!IA AS I*$ICA'#$ B#%&- A*$ !#S'!IC' ',# M#MB#!S '& 0 P#! C&MPA*(11 Me!i$a' O#$ers23 Safety )ea!s 4 Safety Manager 4 Safety O#$er5 6ro!u$tion 4 La- )ea!sName 7 Signature of the Sponsoring Authority