Registration Form - Diversity Dialogues : National Theatre of the Oppressed Conference.
Your name *
Age
Address *
City with PIN Code *
E Mail ID *
Telephone no. *
Name of your organisation
Address
Website of your organisation
Have you participated in a Theatre of the Oppressed workshop before? *
How did you come to know of this Conference? *
Languages you know *
Your reasons for enrolling for this workshop. *
You would like to register for: *
IMPORTANT: Please register for the 3 day workshop with Sanjoy Ganguly ONLY if you have participated in or facilitated a Theatre of the Oppressed workshop previously.
Accommodation
Book your accommodation at Vidyadeep College *
Rs. 650 per night for twin sharing room; Rs. 750 per night for single room.
Check in date (after 12 noon)
MM
/
DD
Check out date (before 12 noon)
MM
/
DD
Number of nights
Payment Details
Payment details *
Make your Cheque/Draft, payable in Bangalore, to Centre for Community Dialogue and Change , and courier to Dr. Radha Ramaswamy, A-6, Grasmere Apartments, Osborne Road, Bangalore 560 042. Tel. 080 2537 0408 : Add Rs. 30 for outstation cheques : Name of the Account : Centre for Community Dialogue and Change : Account No:066501000021148 : Indian Overseas Bank, Sivanchetty Garden Branch, Bangalore. IFS Code: IOBA0000665. Please include all charges - including accommodation - in one payment. Rs. 3000 for Workshop : Rs. 2000 for Conference : Rs. 5000 for Workshop and Conference. Room Charges: Rs.650 per night for twin sharing and Rs. 750 per night for single room. (Breakfast and Dinner included). No one turned away. Please see our financial support policy at this link : http://goo.gl/kCCF0k
Bank name, Branch *
DD/Cheque number and date
Date of Electronic transter
Amount *
Submit
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