Workshop for Teachers and Educators

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DEPARTMENT OF PSYCHOLOGY

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Venue: Auditorium Block, Christ University Campus, Hosur Road, Bengaluru – 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) or 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

Workshop for Teachers and Educators Department of Psychology, Christ University Hosur Road, Dharmaram College Post Bangalore – 560029, Karnataka.

Date:………... Signature: ……….

Name of the institution CHRIST UNIVERSITY

Name of the bank THE SOUTH INDIAN BANK LTD

Branch CHRIST UNIVERSITY

Address CHRIST UNIVERSITY CAMPUS, HOSUR ROAD,

BENGALURU – 560 029

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.