17th National Conference of Catholic Psychologists of India (CCPI) Reg.Form

REGISTRATION FORM

Name: ___________________________________

Age:    __________ Sex:    _________ 

Congregation/Diocese/Institute/Clinic____________________________________

Professional Qualifications: ____________________________________

Address (with Pin code): _________________________________________________

                                       __________________________________________________

E-mail:                          ___________________________________________________

Mobile:              __________________

Major Areas of Expertisein Psychology & Counseling:__________________________

·        Participant for the Conference: Yes/NO

·        Senior Citizen Yes/No

·        Paper/ Poster Presentation on the theme of the Conference: Yes/No

·        Modes of Accommodation you would like to have:    AC Single /Double Room /Three in One

 

Total Fees:                       

NB :If you have confirmed your participation for the Conference it is enough to pay the fees in cash only, on arrival at the Venue.

·        You are requested to send in your  duly filled in registration form to:

Email ID: ccpigoa1716@gmail.com           

Contact:Fr.CliffordCastelino (Conference Co-ordinator) Mb: 9922650210;

 Fr. Henry Falcao (Local Organizer)Mb: 7744840083,Dr. Jose Puthenveed(CCPI, Secretary)

Mb: 9447189614

·        The payment specified below is inclusive of all the operating costs of the conference.

·        Those presenting papers/posters need to register for the conference.

·        The last date to submit abstract is 25^thAugust and full paper before 15^thSeptember 2016

·        The last date for registration and confirmation of participation is 15^thSeptember 2016

·        Those of you who for some reason may not be able to attend the Conference are requested to fill in the form, since it will also help us to create a database for CCPI.

·        Please Inform/ invite all of your associates and colleagues, who are Catholic Psychologists who would be interested to attend the Conference.

REGISTRATION FEES

Delegates	Fees	All Inclusive Fees
		AC Single room		Single room		Double room		Triple room
		With LB	Without LB	With LB	Without LB	With LB	Without LB	With LB	Without LB
Resident CCPI Members
Senior citizens	---	5,900	6,000	4,100	4,200	3,200	3,250	---	---
Others	---	---	---	4,200	4,300	3,300	3,350	3,000	3,050
Non-Resident CCPI Members
Senior citizens	2,250	---	---	---	---	---	---	---	---
Others	2,400	---	---	---	---	---	---	---	---
Resident Non-Members	---	6,300	---	4,600	---	3,600	---	3,400	---
Non-Resident Non-Members			2,600 (without accommodation and half day outing)
Resident Students			2,000 (three in a room)
Non-Resident Students			600 (without accommodation and half day outing)

*LB – Loyalty Benefit

Please Note: You are requested to send in your duly filled in form above, specifying your mode of accommodation to Email ID: ccpigoa1716@gmail.com,        this will indicate your confirmation and participation at the Conference.

Name/Signature:_________________

Date:__________