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Registration Form for Industrial Summer Training at Pune

( To be filled in Capital letters only and signed by HOD )

Student Name : ………..……………...........................................................………………………………………………….

Sex : M / F Email Address : …………………...........……………………… Mobile : ………………...............................

College Name : ……………………………………………………….…………….................................................................

Address ………………………………………………………………………………................................................................

………………………..................................................….City :…......…………………….Pin code ……………………......

Branch : …………....................................…………..Year ……........................................…………

Student’s Permanent Residence address : …..…..........................................................…………………………………..

………………………..................................................….City : …......…………………….Pin code : …………………......

Resi. Tel. No. ………………………........................……. Std Code : ……………..................................

Batch Date ( Tick any one ) :

28th May 07 4th June 07 11th June 07 18th June 07 2nd July 07 9th July 07 16th July 07 6th Aug 07 13th Aug 07 10th Sept. 07 15th Oct 07

Please tell us if you wish to finish 4 weeks course in 2 weeks Yes / No


( In 2 weeks we shall double the hours per day )

No of students joining the summer training : …………..............................................................................................

Do you want accommodation Yes / No (extra cost)

We are enclosing the DD of Rs 7500/- in favour of “Automation andControl Systems“ payable at Pune

DD No : …….............…......... Dt. ……................……… drawn on bank …………………………….............................

HOD Name : ………………………………....................……………… Dept. : ……………………….................................

Email : ……………………………………………………….Mobile : ……………………………................

Signature and Stamp of HOD

Note : The Registration form must reach us 10 days before the course starts along with payment. Change of dates
is allowed if informed before 8 days of the batch date.
To get the conformed seat , send advance of Rs 1500 along with registration this form + last semester mark
sheet zerox + college ID card zerox

Send the duly filled form to :


Automation and Control Systems
(House of Industrial Automation)
“ACS”, Plot No 144 A, Sector 7, PCNDTA, MIDC Bhosari, Pune 411026 INDIA
Tel : +91- 20- 27119405 / 21725981 / 27119505 Fax : +91-20-27119405
Email : acsindia@vsnl.com, trg@acs-india.com Web : www.acs-india.com and www.plctrg.com

Please use Xerox if you need extra copy of this form

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