Registration Fee details
Specialty | Before 15th February 2011 | After 15th Feb 2011 |
Professionals | Rs.750/- | Rs.1000/- |
Students* and parents | Rs.500/- | Rs.750/- |
*Student registrations should accompany bonafide certificate issued by the Head of the Department.
Please note: Registration Fee includes Registration kit, course materials, lunch and tea on both days.
Payments can be made in form of cash or cheque or DD in favour of “Sri Ramachandra University”, payable at Chennai.
Please fill the registration form and mail it along with the payment to Ms. Amudhu Sankar, Treasurer, Autism Seminar 2011, DEPARTMENT OF SPEECH LANGUAGE AND HEARING SCIENCES, SRI RAMACHANDRA UNIVERSITY, Porur, Chennai - 600116.
If you have any queries about registration, please feel free to contact Ms. Amudhu Sankar at 9940422338 or 45928500 Ext 320/321.
Registration form
Name:
Specialty: Please tick the appropriate specialty below
Speech & language pathologist/ Occupational therapist/ Special educator/ Psychologist/ Parent/ Student*/ Others
Designation:
Address:
Organization:
Mobile:
Email:
Amount Paid:
Payment mode: Cash/ Cheque/ DD
Cheque/DD details:
Bank and Branch:
Cheque/DD No and Date:
Place and Date:
Note: This form can be photocopied and used for multiple registrations.
……………………………………………………………………………………………….................
*Bonafide certificate
I hereby certify that Mr./Ms.…………………………………… will be a full time student as on 25th February 2011.
Department & Institution:
Office Phone:
Signature of the delegate
Signature of Head of Department with seal:
Date:
