MARIAVIDYANIVAS Ursuline Center for Counselling and Psychotherapy #134 Udayagiri, Mysore Karnataka Ph: 0821 2452604 Mobile: (+91) 9743468821 and 73534558103 Website : www.mariavidyanivas.info Email : [email protected] APPLICATION FORM For The Four-Week Counsellor Training Programme (May be down-loaded from our website) The Counsellor Training Programme the duration is four weeks. (Fee is Rs.10 500). Dates: April 14th to May 12th 2015 ******** NAME (in Block Letters) (Please indicate your Title as Mr./Ms./Fr./Sr./Br./etc) _________________________________________________________________ Date of Birth _______________Age ______Gender _________Religion ________________ Complete Postal Address: (in CAPITAL LETTERS): _______________________________________________ _______________________________________ ______________________________________________________________________________ -----------------------------------------------------------------------------------PIN code: -------------------Phone No: ______________________ Cell No: ________________________ E-mail ID: _________________________ Kindly draw a Demand Draft (DD) for Rs.500/towards the Registration Fee, in favour of “The Director, Mariavidyanivas” -- payable at Mysore, and send it along with this application form. The envelope may be addressed to: Director Maria vidya Nivas #134 Udayagiri, Mysore 570 019 Karnataka Your Signature……………. Amount DD No.
© Copyright 2024 ExpyDoc
