Two Days Library Workshop on "KOHA"
on 8th,9th May 2017 (Mon,Tue) at MADIN POLYTECHNIC COLLEGE CAMPUS, MALAPPURAM
1.Name (Full Name in BLOCK letters)
*
2.Gender
*
Male
Female
3.Date of Birth
*
-
Day
-
Month
Year
Date Picker Icon
4. Designation
*
5.Institution/Organization
*
6.Official Address
Street Address
Street Address Line 2
District
State
Zip Code
7.Personal Address
*
Street Address
Street Address Line 2
District
State
Postal / Zip Code
8.Office Phone
9.E-mail
*
10.Mobile Number
*
11. Whether using KOHA in your Organization
*
Yes.
No.
12.Have you attended any Workshop/Seminar in Madin Polytechnic Before ?
*
Yes
No
14.Food Preferance
*
Vegeterian
Non-Vegeterian
13.Accommodation
*
Required
Not Required
14. Your Photo ( Selfie and clearless photo not accepted)
*
Payment Details
Regsitration Fee: Rs.1000/- (RTGS or DD) in favour of Principal Madin Polytechnic College, Malappuram. For RTGS Transaction: A/C No. 67282659065, The Principal, Madin Polytechnic College, Malappuram, SBT, Malappuram Main Branch, SBTR0000196
15.Payment Details
*
DD
RTGS
16.Demand Draft No. and Date
DD No.
Date
17. Upload Scanned Copy of DD/Cheque
*
Registration will be confirmed only after receiving of Payment Receipt in College office
Register
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