Registration

Seminar on “Communication Challenges in the Present Times”

Chief Guest: Shri Dileep Padgaonkar

24^th January Thursday 2013, at Symbiosis Bengaluru Campus

Registration Form

Please register the following for the seminar

Participant 1:

Name:____________________________________ Designation:_______________________________

Email:____________________________________  Mobile No:________________________________

Participant 2

Name:____________________________________ Designation:_______________________________

Email:____________________________________  Mobile No:________________________________

Participation fee for Students  - INR 500/-

Participation fee for Delegates  - INR 1000/-

Enclosed is the participation fee of Rs.__________ by DD/Cheque no__________in favor of Symbiosis Institute of Media and Communication, payable at Bengaluru.

Nominating Authority:		Designation:
Organisation:
Address:

Tele / Fax:                                                                          Email:

Website:         ______________________________________

Form to be sent to:

Symbiosis Institute of Media & Communication

# 95/1, 95/2, Electronic City Phase I,

Hosur Road, Bengaluru-560 100

M: 7676676700

Email: raji@simc.edu.in