UNIVERSITY OF JERUSALEM (British American Autonomous Body) 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 mail : [email protected] WebSite : www.ujglobal.org www.facebook.com/ujglobal UJ’s 19th INTERNATIONAL CONVOCATION & ORDINATION REGISTRATION FORM Date: Friday the 06th 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 6 Visitors Freewill Offering 7 Res: Mob: I am sending the following fees for myself (Please tick the relevant below) Registration Fees - US $20 Gown - US $10 Graduation Fees - US $10 towards________Degree Ordination Fees - US $_________ Honorary Doctorate Fees- US $___________towards___________Degree The no. of persons, who will accompany me:______________ I am sending herewith US $ ________as Offering. I am sending herewith US $ ________For Scholarship for needy need Pastors. I am sending herewith US $ ________For Handicapped Ministry. I am sending herewith US $ ________For Free Course Materials. Amount Sent By: _______________ ______________ Reference No: _________________________ ________________________ Date: …………………………………………. Signature: …………………………………………………………………………………. ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Attention please: 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. Kindly Note: The Conference Registration Fees, Graduation Fees, Ordinati Ordination on Fees, Honorary Doctorate Degree Fees and Gown Fees are non non-refundable. Kindly bring the copy of the E-mail pertaining to your payment and produce it in the Registration Counter at the Conference Venue. Communication : If there is any change in your address, please inform us. --- ---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 Nadu, India - 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 or 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 119th Convocation Scholarship. My Name: - ……………………………… ………………………………Associate Associate Number………………………… Number……………… My Address: - …………………………………………………… …………………………………………………………..……………… ……………… …………………………………………………………………….……………….……. ………………………………………………………… …………………………………………………………ZipCode: ….…………….……. ….……… Phone Number:- …………………………… Cell:- ……...…………………………….. ……...……………………… E-mail ID:Degree Chosen by me:- …………………… Language: - …………………………… ……………………… Date: - ………………… Signature: -………………………………………… ………………………………………………