LBC - Summer School 2019
REGISTRATION FORM
Email address *
VALID IDENTITY PROOF
Please send us a scanned copy of any valid Identity Proof (College ID / Election Card/ Driving License). Copy of relevant pages of Passport and Visa in case of non-Indian nationals shall be attached. This scanned identity proof along with a scanned passport size photo of the participant shall be attached and sent separately via e-mail to lauriebakercentre@gmail.com for the registration form to be considered valid.
SELECT YOUR BATCH OF PREFERENCE *
FULL NAME *
Your answer
GENDER *
Date of Birth *
MM
/
DD
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YYYY
CONTACT TELEPHONE NUMBER *
Your answer
NAME & ADDRESS OF EDUCATIONAL INSTITUTION (Last attended or attending)
Your answer
WORK EXPERIENCE, IF ANY (Name of institution and type of work)
Your answer
DATE & TIME OF ARRIVAL (Include train/flight number)
Your answer
DATE & TIME OF DEPARTURE (Include train/flight number)
Your answer
ADDRESS FOR COMMUNICATION *
Your answer
PERMANENT ADDRESS
Your answer
PERSON TO BE CONTACTED IN CASE OF EMERGENCY
Please enter the name, telephone number and relationship with the emergency contact person.
NAME *
Your answer
TELEPHONE NO. *
Your answer
RELATIONSHIP
Your answer
ACADEMIC FIELD(S) OF INTEREST
Your answer
FOOD PREFERENCE *
DATE OF REGISTRATION:
MM
/
DD
/
YYYY
SIGNATURE OF PARTICIPANT(to be signed only after arrival in LBC)
Your answer
REGISTRATION FEE
Please select payment option by either demand draft or online transaction. The Registration form should be accompanied with an advance registration fee of a minimum Rs.10,000/- (option to pay full amount also exists). Please consult LBC Summer School 2019 brochure for details of payment. No registration form will be accepted without advance registration fee of Rs.10, 000.
FEE TRANSFER FORMAT
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