REGISTRATION FORM - LAST DATE – JANUARY 25, 2007

SPECIAL LECTURES AND WORKSHOP ON

CONSCIOUSNESS, SPIRITUALITY, AND WELL-BEING  

February 12th to 17th, 2007

INSTRUCTION: Take a print out, fill in the form, sign (original signature required) and mail it along with DD to Prof. S. K. Kiran Kumar, Chairman, Department of Studies in Psychology, Manasagangotri, Mysore – 570006.

NAME

 

GENDER

MALE

FEMALE

DESIGNATION

 

INSTITUTION

 

ADDRESS - OFFICIAL



 

ADDRESS - RESIDENTIAL



 

ADDRESS - E-MAIL

 

PHONE NUMBERS
O -
R -
M -

 

DD DETAILS

AMOUNT
DD NO.
BANK

ACCOMMODATION REQUIRED

YES

NO

PLACE

DATE

SIGNATURE


 

 

 


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