UNIVERSITY OF JERUSALEM Post Box No. 26, No.237, Gospel Church Street, GST Road, Kadaperi, West Tambaram, Chennai, Tamil Nadu - 600 045, India Ph : +91-- 44 – 2238 3974, 3242 6288 Fax : 4204 0107 Cell : 0 - 9094949491 E--mail : [email protected] WebSite : www.ujglobal.org www.facebook.com/ujglobal UJ’s 19th INTERNATIONAL CONVOCATION & ORDINATION REGISTRATION FORM Date: Friday the 6th March, 2015 from 1:30 p.m. to 5:30 p.m. Venue: APOSTOLIC CHRISTIAN ASSEMBLY (ACA Palavaram) Land Mark: Pallavaram Railway Station (Near Airport) No.12-A, A, Eswari Nagar, Pallavaram, Chennai - 600 043,Tamil Nadu, India. 1 2 3 4 5 Name Associate Number Phone Number Email Id Fees Particulars for Graduates / Ordinates / Honorary Doctorates Res: Mob: I am sending the following fees for myself (Please tick the relevant below) Registration Fees - Rs.500/Gown - Rs.200/Graduation Fees - Rs.300/- towards _______ Degree Ordination Fees - Rs. ________ Honorary Doctorate Fees - Rs. _________ towards _______ Degree 6 Visitors The no. of persons, who will accompany me : ________ I am sending herewith Rs.________as Offering. I am sending herewith Rs. ________For Scholarship for needy need Pastors. Freewill Offering I am sending herewith Rs. ________For Handicapped Ministry. 7 I am sending herewith Rs. ________For Free Course Materials. Mode of Payment: By M.O. No._____________ No._______________________ dated __________ By D.D.. No.____________ No._______________ dated _______________Bank_____________ ____________________ Date: …………………………………………. Signature:…………………………………………………………………………………. …………………………………………………………………………………. ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Kindly Note: Travel and Accommodation expenses are to be borne by you and arrangements have to be made by you. We will send the List of nearby Hotels to those who register. The Conference Registration Fees, Graduation Fees, Ordination Fees, Honorary Doctorate Degree Fees and Gown Fees are non-refundable. refundable. If you have paid earlier, kindly produce the receipt or inform the details of the payment at the Registration Counter in the Conference Venue. Venue If there is any change in your address,, which is pasted on this letter’s envelope, please inform us your correct address. ---------Cut here, take ake any number of Photocopies (Xerox) and pass them on to others-----University of Jerusalem, Post Box No. 26, No.237, Gospel Church Street, GST Road, Kadaperi, West Tambaram, Chennai, Tamil Nadu - 600 045. Cell : 0 – 9094949491 [email protected] www.ujglobal.org www.facebook.com/ujglobal UJ’s Offer for New Enrolment Special 19th Convocation Scholarship for Men and Women – (Until March 31, 2015 201 only) Scholarship For those who pay Full Fees: Bachelor – 20% Master – 20% % Doctorate – 20% Scholarship For others: Bachelor – 10% Master – 10% Doctorate – 10% -------------------------------------------------------------------------------------------------------------------------Please enroll me as your student and award me the special 19th Convocation Scholarship. My Name: ……………………………… ………………………………………………….….……. Associate Number: ……………………… My Address: …………………………………………………… …………………………………………………………..……………………………………………………………………. ……………………………………………………. ……………………………………………………………………….………………….……………………………… …………… ………… ……………………………………………………………………….… ……………………………………………………………………….………………….……………………………… ………….………………………………PinCode:…………… Phone Number:…………………… Cell:… ……………………………………………………. Email ID: I wish to enroll in ………………….. Language: ………………… Date: ………………………… Signature: ……………………………………………… …………………………………………