Registration Form Program : Reflections And Realizations Conduct Date : 1. Participants Information Full Name Title Mr. Ms. Prof. Dr. Other DOB Marital Status Family Members Phone (M) (R) Email Address Education Occupation Designation Interest (hobbies) Health Condition Regular Medicine (if any) Allergies (if any) 2. Admission Fee : NRs. 9,800.00 Admission fees include Program fee, Accommodation, Breakfast, Lunch,Dinner, Snacks, Program T-shirt and Registration materials. 3. Notes How do you come to know about the program ? Newspaper Facebook Friend Other (Please Specify) Why do you want to join the program ? Any other information that organizer should be aware of : Terms and Conditions Accommodation will be on twin sharing basis Only vegetarian food will be served The program will have 20 participants in one intake; the exceeding applications will be accommodated in subsequent program The registration fee has to be deposited within one week from the date of confirmation in following account: Account Name: Bijay Rajbhandary Vibor Bank A/C No.: 0010049501 Details of Contact Person in case of emergency Name : Phone : (M) (R) Processing..Please wait.. Image size <= 250 KB; Upload PP image if you have. Image
