Cheque or Demand draft in favor of “ Society for Hand Therapy,India” payable at Mumbai.

Last Date for registration: 19th March, 2011

Please send at : Hemant Nandgaonkar, B/302, Heritage Holy, Near Apna Baazar,

Jawaharlal, Nehru Road, Mulund west, Mumbai – 400080,

Limited seats Only

REGISTRATION FORM

"Research Methodology for Hand Therapists"

 NAME - _____________________________________________________

ADDRESS FOR COMMUNICATION –

RESIDENCE: ________________________________________________________________________________________________________________________________________________

INSTITUTION: ________________________________________________________________________________________________________________________________________________

CONTACT NUMBER :( with city & area code)

RESIDENCE: ________________________________________________

WORK: ______________________________________________________

MOBILE: ____________________________________________________

Email - _____________________________________________________

PROFESSIONAL STATUS:________________________________________________

________________________________________________________________________

Demand Draft /Cheque number with date:

_____________________________________________________________

_____________________________________________________________

Signature of the applicant