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Tata Institute of Social Sciences
Alums Association (TISSAA)
REGISTRATION FORM
FOR WORKSHOP ON 'APPROACHES TO SOCIAL RESEARCH'
JUNE 25­27, 2015
Participant Details
First name
Middle name
Last name
Gender: Male / Female / Others Name of Organization/Institute/Company/Self Designation
Address (Organization/Institute/Company/Self) Pin Code
Tel. No. Mob. No. E­Mail Address Registration Procedure (Registration fee amount is mentioned in the Brochure)
A participant can pay his/her registration fee by cheque/DD in favour of “Tata Institute of Social Sciences Alums Association” payable at Mumbai and send it along with the filled­up Registration form and send to the Alumni Office (address mentioned in the footer note).
OR
The payment can also be made directly at ICICI Bank anywhere in the country or through on­line transfer to “ Tata Institute of Social Sciences Alums Association A/c No. 109801000823” (RTGS/NEFT IFSC Code: ICIC0001098; Home Branch: Deonar, Mumbai 400088) while e­mailing the payment details along with scanned copy of the Registration Form at [email protected]/[email protected] Declaration
In case TISSAA finds any incorrect information provided in the application form, TISSAA reserves the right to cancel the registration for workshop without any notice. In such cases, the registration fees paid by me/my organization shall not be refund/claimed by me. Signature Date Enclosed: Cheque
Address: Tata Insitute of Social Sciences Alums Association, Room No. 11, Prof. M.S. Gore Academic Building, Naoroji
Campus, TISS, Farm Road, Deonar, Mumbai – 400088. Phone No. 022-25525918. Email ID:
[email protected]