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'Inviting Emerging Future' - (Bangalore) Registration Form

24th - 27th November 2010, at Fire Flies, Bangalore, India.

Name

Organization

Address

Phone Number

Email ID

Why do I want to attend this workshop?

What are the questions(in my mind related to my current reality or my future) for which I am seeking answers for (in this workshop)?

Preferred date/time for a call(Please specify 3 alternative date/times for a pre-program discussion) & the preferred phone number:

Fee paid

Payment details

Any other relevant information

Mail this form to: raja@solsouthfoundation.com / rajachid@gmail.com (OR) Courier to: Raja Chidambaram, SoL South Foundation, C-3-1207 – L&T South City, Off Bannerghatta Road, Bangalore – 560076.

Payment:
Cheque/Demand Draft be drawn in favor of “SoL South Foundation” payable at Chennai.
Online transfer can be made to: SoL South Foundation, A/C No: 30690239232., State Bank of India, Tiruvanmiyur Branch, Chennai, Tamilnadu 600041, IFS Code: SBIN0001985