Online Registration - Selected Workshops

Full Name*
First Name Middle Name Last Name
Age*
Sex*

Male Female

Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

E-mail*
Mobile / Phone*
Profession*
Years of Experience*
Educational Qualification
Interests & Area of Specialization
You are a*

Indian National Foreign National/NRI
Which program are you registering for?*

Teachers and Parents Workshops Medical Workshops
Choose your mode of payment*

Bank-to-Bank/Wire Transfer (National/International) Cash/Cheques Deposited in Axis Bank Branches any where in India Cheque/DD posted to our address
Registration fee for Teachers and Parents Workshops:

Fee: Rs. 2500 per workshop (for 7 days)
(Please calculate the total amount based on number of workshops you select)

Lunch will be Rs. 1250 extra.

Registration fee for Medical Workshops:

Fee: Rs. 1000 per workshop (for 2 days)
(Please calculate the total amount based on number of workshops you select)
Amount
Cheque/DD No.
Bank Name
Date of Cheque/ DD
Day Month Year
Do you require day-care facility for your children?

Yes No
If YES, please select the appropriate option(s) below based on the age group of your child/children and
add the necessary fee to your registration fee while making a payment.

Please add Rs. 2000 per child.

There will be no transportation charges for children using the day care facility at Abhaya. The day care charges of Rs. 2000/- per child includes the transport costs.
Number of children between 3 - 6 Years

1 2 3 4
Number of children between 6 - 9 Years

1 2 3 4
Please note: If you are a Teacher/Parent participant, the following workshop options need to be chosen.

In case you are attending the Medical workshops, please ignore the workshop options given below.
Workshop 1 (11:00 AM - 12:15 PM)

Registration fees for Teachers/Parents - Rs. 2500 ( 7 days) , Registration fees for Medical professionals/Parents - Rs. 1000 ( 2 days)
First Preference
Second Preference
Third Preference
Workshop 2 (1:00 PM - 2:30 PM)

Registration fees for Teachers/Parents - Rs. 2500 ( 7 days) , Registration fees for Medical professionals/Parents - Rs. 1000 ( 2 days)
First Preference
Second Preference
Third Preference
Workshop 3 (3:00 PM - 4:30 PM)

Registration fees for Teachers/Parents - Rs. 2500 ( 7 days) , Registration fees for Medical professionals/Parents - Rs. 1000 ( 2 days)
First Preference
Second Preference
Third Preference
Should be Empty:

Partial Registration for Specific WorkshopsPlease fill in the details below for partial registration for specific workshops.

Workshop 1 (11:00 AM - 12:15 PM)

Workshop 2 (1:00 PM - 2:30 PM)

Workshop 3 (3:00 PM - 4:30 PM)

Partial Registration for Specific Workshops
Please fill in the details below for partial registration for specific workshops.