VI  INTERNATIONAL CONFERENCE ON

PEACE AND NONVIOLENT ACTION (VI  ICPNA)

 

First Part –    International Dialogue on the Challenge of Violence, Hunger and Poverty: Evolving Sustainable Countermeasures

(23rd Dec. to 25th Dec., 2007)

 

SECOND PART –            First International Nonviolence Training Camp

(26th Dec. to 28th Dec., 2007)

 

Venue: Children’s Peace Palace, ANUVIBHA

Rajsamand, Near Udaipur (Rajasthan) INDIA

 

REGISTRATION   FORM

 

COMMON FORMAT FOR BOTH THE INTERNATIONAL DIALOGUE AND

NONVIOLENCE TRAINING CAMP

 

1.         Full Name of the Participant      ______________________________________________________________

                                                            Family Name                                         First Name                             Middle Name

 

2.         Title: Mr./Mrs./Ms./Dr. etc.:      ______________________________________________________________

 

3.         Age (Years): __________     Male or Female:_____________4. Nationality:_____________________

 

5.         Passport No.(If a foreigner):     ______________________________________________________________

 

6.         Postal Address:                        _________________________________________________________

            City/Postal Code:                     _________________________________________________________

            Phones: Res.:___________________________  Office:____________________________________

                        Fax: ____________________________ Email:_____________________________________

 

7.         Institution/Affiliation:                  ______________________________________________________________

 

8.         Accommodation:          (For those who are only attending the three-day international dialogue)

           

(1)                 Do you want to stay in the rooms at the venue?  If yes, tick or circle the dates:

December, 2007         22nd                 23rd                  24th                  25th                  26th     

 

            (2)        Do you want to stay in tented accommodation at the venue?                    Yes  /  No.:    ________

 

(3)        Do you want to stay in a hotel at Rajsamand away from the venue?   Yes  /  No.:           ________

If yes, please state your preference______________________________________________

 

-2-

 

11.  (For those who are attending the international dialogue as well as nonviolence training camp and also for those who are only attending nonviolence training camp).

Note : Nonviolence training camp will be residential and all the participants will have to stay at the venue of the conference. Those who can stay in rooms or tented accommodation for this camp are encouraged to fill in the column.

             I want accommodation on the dates ticked here :

December, 2007         26th                  27th                  28th                  29th     

 

Common for all delegates

 

10.       Date and Time of          (i)         Arrival: _____________________________________________

            (Please mention clearly)      (ii)        Departure:        _____________________________________________

 

11.       Additional information about you:                      _________________________________________________

                                                                                    _________________________________________________

 

Signature:______________________

 

 

Note :   Those who are interested should fill in the registration immediately and email it to the secretariat with or without registration fee. The fee can be paid later.

 

 

 

 

 

 

 

Please Email or fax or airmail to:

Dr. S.L. Gandhi

President

ANUVRAT GLOBAL ORGANIZATION (ANUVIBHA)

Opp. Gaurav Tower, Malviya Nagar

JAIPUR-302 017 (Rajasthan) INDIA

Tel: 91-141-4017989/5127358     * Fax: 91-141-2710118    * Mobile: 098280-16989

Email: <slgandhi@hotmail.com> or <anuvibha@sify.com>