National Seminar On
Child Protection in India: Empowering Mental Health Professionals Observing the International Day for Prevention of Child Abuse and Neglect
November 19, 2015
Christ University, Bengaluru Hosur Road, Bangalore – 560029
REGISTRATION FORM
Full Name: ………...Sex: (M) (F) Designation: ………...
Affiliation/Institution: ………...
Mailing Address: ……….………...
……….……….………...
Mobile No: …………...Email….…………... ...
Accommodation Required: Yes/No Food Preference: Veg/Non-veg
Payment Mode (Please tick the option): Online Payment (Refer to details below) Demand Draft/Cheque Demand Draft /Cheque drawn in favour of “Christ University”, payable at Bangalore.
Details of the Draft: D.D./Cheque No. ………..…Amount (Rs)...
Date: ………...Name of Bank: ... ...
Note: Please mail this form along with the Demand Draft/Cheque to the:
THE ORGANIZERS
National Seminar on ‘Child Protection in India: Empowering Mental Health Professionals’ Department of Psychology, Christ University
Hosur Road, Dharmaram College Post Bangalore – 560029, Karnataka.
Date: ………... Signature: ……….
DETAILS OF BANK ACCOUNT
Name of the institution CHRIST UNIVERSITY
Name of the bank THE SOUTH INDIAN BANK LTD. Branch CHRIST UNIVERSITY Type of account SAVINGS Account No. 0396053000015000
MICR code 560059010 IFSC SIBL0000396 Swift code SOININ55
Note : Please email a screenshot of the online transaction details to the organizers along with the registration form.
