The Fourth South Asian Regional Conference in Community Based Rehabilitation

The Fourth South Asian Regional Conference


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Hosted jointly by
CBR National Network- Nepal Government of Nepal Ministry of Women, Children & Social Welfare National Federation of Disabled- Nepal South Asian Regional Network In CBR, Bangalore,India

CBR

CBR National Network-Nepal
South Asian Regional Conference in CBR
Registration form

Title

First name *

Last name *

Organisation *

Position *

Address *

City *

Post/Zip code *

Telephone number *

Fax number

E-mail address *

Website address

For name badge

(Please show exactly how you would like your name badge to be displayed)

Name *

Organization *

Country *

Delegate Fees : ( Please tick as appropriate )

Nepalese		South Asians		Others
Before 15 August 2007	After 15 August 2007	Before 15 August 2007	After 15 August 2007	Before 15 August 2007	After 15 August 2007
NRS.2,500	NRS.3,500	US$75	US$100	US$100	US$150

Dietary requirements: *

Particular requirement (ie. Accessibility and alternative formats): *

Payments

Payments can be made through cheques, bank drafts and bank transfer. Please note that you must agree to pay all bank charges at the sending and receiving banks

Bank details:
Nepal Investment Bank
Seepadol Branch Bhaktapur
Ph: 016612832 Fax: 97716616617
Swift code : NIBLNPKT
Bank Account: 0022073140

CBR National Network- Nepal

Government of Nepal Ministry of Women, Children & Social Welfare

National Federation of Disabled- Nepal

South Asian Regional Network In CBR, Bangalore,India