Mr/Ms .............................................................................................................................................................................................................................
(Last name First Name) .................................................................................................................................................................... |
Please Tick, Broadcaster/ Government Organization/ Media Professional/ Media student/ Teacher/ Parent/ Educator/ NGOs/Others |
Organization.................................................................................................................................................................................................................... |
Department..................................................................................................................................................................................................................... |
Position......................................................................................................................................................................................................................... |
Address......................................................................................................................................................................................................................... |
City.................................................................................................................................................................................................................................
Country........................................................................................................................................................................................................................... |
Telephone ......................................................................................................................................................................................................................
Mobile.............................................................................................................................................................................................................................. |
Email.............................................................................................................................................................................................................................. |
Fee (Demand Draft in the name of CHINH) |
Indian Delegate Rs. 5000/- ..................................................Media Student Rs. 3500/- |
International Delegate 100 Euro ( option to pay on arrival ) |
Declaration
As a registered delegate I agree to abide by the Forum's guidelines on access to the Forum.
Date ...................................................................................................................................................................................Signature
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