REGISTRATION FORM – Internal Audit Academy IIA –BOMBAY CHAPTER Name of participant Designation / Name of Company or firm IIA member (Yes/ No) Email Contact no Payment Information: Please draw Cheque in favor of : Institute of Internal Auditors, India – Bombay Chapter Cheque/Demand Draft No. Date of Cheque Amount (Rs.) Bank Name Branch Send completed registration form along with Cheque/DD : Ms Sweta Achrekar IIA – BOMBAY CHAPTER 209 Sagar Avenue, Opp. Shoppers Stop, Above ICICI Bank Branch , S V Road, Andheri (West), Mumbai 400 058 Tel No 022-67103351 Please email a scan copy of cheque along with registration form to info@iiabombay.org