Participants Confirmation Form

Registration Form I AM INTERESTED in participating in the iVolunteer International Workshop on Volunteer Management in Disability. Please register me as a participant for the workshop being held on the 12th and 13th of November 2008. Name: Mr./Ms/Dr

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Organisation and Designation: ________________________________________ Address: _____________________________________________________ Country: _____________________________________________________ Telephone: _________________________Fax: _______________________ Email: ________________________________________________________ Professional Responsibilities: ________________________________________ ___________________________________________________________________ Your experience of working with volunteers: Extensive / Little / No Experience I would like to use the skills acquired from this training for: ___________________________________________________________________ ___________ ___________________________________________________________________ ___________ I am sending Rs. _________ by way of DD/Cheque No: ___________ Dated: _______________ Drawn on (bank): ___________________ *For International applicants, please contact [email protected] before remittance.

FOR INTERNATIONAL APPLICANTS ONLY: Date of Birth: ______________

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Place of Birth:

Nationality: ______________

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Passport No:

Place of Issue of Passport: _____________ ______________

Date of Passport Expiry:

SIGNATURE AND DATE: ____________________________________