Registration Form

Please send the completed form by email to

Development Associates, House No 2, A N Das Lane,Tootpara, Khulna 9100, Bangladesh

Telephone +880-41-730250, +880-1977-100100, Fax +880-41-730341

Training on

“Participatory Vulnerability and Risk Assessment”

Dates: 9 to14July 2009

Venue: Jessore, Bangladesh

APPLYING FOR COURSES

If you wish to attend any of the Development Associates training courses, please complete the application form and return it with a cheque or Demand draft made out for the correct amount to the Development Associates office (for participants paying in Bangladeshi Taka).

HOW TO PAY
  1. Please send in a separate application form with your cheque for each participant.
  2. On receipt of your completed application form and payment, an e mail will be sent to you in acknowledgement.
  3. Please make cheque/demand draft payable to “Development Associates”. Please note that it is also possible make a bank transfer.
  4. If your organization is paying your fees, please include on the form the organization’s name and address and the name of the person to be invoiced.
  5. Cheques will be cashed seven days before the course begins once we have confirmed your place.

Development Associatesbank details for bank transfer:

a. Bank Account name: Development Associates

b. Bank account no: 33011984

c. Bank Name: Agrani Bank

d. Branch Name: Khan Jahan Ali Road Branch

e. Bank Address: Khan Jahan Ali Road, Khulna 9100, Bangladesh

NOTES

Last date for registration – 25June 2009

  • Fees include tuition, materials, accommodation and all meals.
  • Registration on a course is subject to receipt of payment.
  • Cancellations will be accepted up until two weeks before the course begins and your fee will be refunded.After that date no refunds will be given.

“Participatory Vulnerability and Risk Assessment”

Dates: 9 to 14July 2009

Venue: Jessore, Bangladesh

Course Fee Taka./US$ ...... …………...... Cheque/ Bank draft/ Bank transfer (for payment details ref. previous page)

1. Title Mr/Mrs/Ms. ………………..

Name (as it should appear on the course certificate):

Last/Family Name …...... ………………………………………………………

First and other Names ...... ………….

2. Mailing Address

......

...... …………………......

...... ………………………………………………………………………………………………..……….

Postal code ......

3. Tel: (w) ...... (h) ...... ………Mobile…………………………

Fax…………………………… E-mai......

4. Passport Details: (for participant from countries other than Bangladesh)

Passport number and nationality………………………………………………………….……………

Date and Place of issue………………………………………………………………………………………..,

Date of Expiry……………………(Please mail scanned copy of your passport)

5. Designation: ……….……………………………….. Specialization.....………………………………

Company/Organization ...... ……………………………………………..…………………

6. Previous experience in NGO work

...... ……………………………

7. Present or anticipated role in NGO management work

...... ……………………………………………………………..

8. Dietary Requirements

Status: Vegetarian Non Vegetarian

Where did you hear of Development Associates training?

……………………………………………………………………………………………..