Registration Form

Transcription

Registration Form
ELT@I TIRUPATI CHAPTER
National Level Workshop on
‘Training the Trainers in Virtual Learning’
22 – 23 January 2015
Organized at
K. M. M. INSTITUTE OF TECHNOLOGY & SCIENCES
TIRUPATI, CHITTOOR Dt, ANDHRA PRADESH
(Filled in registration form has to be sent as an e-mail attachment
to Dr. G. Reddi Sekhar Reddy at: eltaitpt@gmail.com)
REGISTRATION FORM
Name of the participant
Designation
Institution where he/she
is working
ELTAI Membership No.
Mobile No.
Email Address
Address for
correspondence
Level of Computer
Literacy
Very Good
Good
Average
Familiarity with Internet
Quite Familiar
Tools (e.g., Blogs,
Familiar to a Great Extent
Facebook)
Familiar to Some Extent
Details of fee paid
(proof to be attached)
Bank name:
Place:
Transaction no:
Date:
Time:
Place:
Date:
Signature