REGISTRATION FORM

REGISTRATION FORM (Last date: September 1, 2006)

COURSE: CRPPG Workshop – October 1-12, 2006

Please use a separate (photocopy) form for each participant. The fees include course fees, material, food and accommodation and field visits.

Note: The course fee does not include travel and transport to and from the venue, translators’ fees or medical insurance. Participants are requested to ensure that they are enrolled in a medical insurance scheme if they are not already covered.

PLEASE USE BLOCK LETTERS

NAME____________________________ ADULT CHILD AGE________

ORGANISATION______________________ DESIGNATION___________________

ADRESS_____________________________________________________________

CITY ____________________ PIN _____________ STATE ___________________

COUNTRY_________________________________

TEL (with code) ____________________

EMAIL ____________________________

Yes I want to register for the workshop

Fee in Indian Rupees INR 25,000/-

Fee in US Dollars USD 600/-

I enclose a demand draft no: _________________________ dated ____________________ for the amount of INR 25,000/- USD 600/- (tick what is applicable) payable to The Concerned for Working Children, Bangalore, India.

Date and seal of organisation

Signature of applicant