E-Outreach : New media technologies for advocacy and strategic communication

Date: January 29-31, 2013 New Delhi

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Name: *

Age: *

Organisation: *

Address: *

Email: *

Facebook address:

Twitter address:

Website:

Contact telephone: *

Fax:

Designation: *

Your educational background (Title / Degree; Institution; Year; Subject): *

Your work experience (Period; Position; organization): *

Present Responsibilities: *

Why you wish to attend this course (2-3 sentences): *

What does the participant expect to learn?: *

Payment Options: *

Cheque

Demand Draft

Credit Card

Please add Rs. 15 for outstation/ non-Delhi cheques:

DD/Cheque No. / Dated:

Cheque/DD drawn in favour of Centre for Scienc and Environment

Would you like us to make arrangements for your accomodation (on payment basis): *

Yes

Name of the Nominating Authority and Designation:

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