Registration Form

PARTICIPANT DETAILS

Name of Participant:

Designation:

Organisation:

Address:

Telephones:

E-Mail:

Nature of Organisation: 5 Not-for-profit/ NGO 5 For Profit

MATTER ENCLOSED/ATTACHED

A paragraph about yourself: 5 NO 5 YES Filename:

A paragraph about your organisation: 5 NO 5 YES Filename:

Other relevant documentation: 5 NO 5 YES Filename:

For not-for-profit organisations/ NGOs/ Institutions:

Do you use sport as a medium to conduct your programmes? 5 YES 5 NO

If Yes:

What is the model you use?

Which sport do you use to support your development programme?

Is the model oriented towards children/ women/ community as a whole?

Do you have a system of assessing the impact of your programme on the target group? If so, please provide a brief.

If No:

Does your organisation acknowledge sport as an effective medium to bring about positive social change? Would you like to try using this in future?

For profit making organisations/ corporates:

Do you support/endorse any sport as part of your brand promotion activity? 5 YES 5 NO

If Yes, which sport do you endorse?

Does your organisation participate in corporate tournaments? 5 YES 5 NO

If Yes, please provide information on the last two such events organised, or in which your organisation participated.

REGISTRATION INFORMATION

Registration fees per person:

·  Conference (19th May 2010): Rs.1500

Please note:

Payment should be made before 30th April 2010 by Demand Draft payable in Mumbai, favouring:

“Childlink India Foundation”

Kindly send your payment by courier or registered post to the Mumbai Secretariat:

NOTES

- Each participant must register individually. Please use a separate form for each participant.

- The Registration fee for the conference includes participation in the conference and lunch.

- The Registration fee for the conference does not include accommodation.

- The schedule is subject to change.

For any further information or assistance kindly contact the Conference Secretariat.

CONFERENCE SECRETARIAT
Sheetal Satam
Senior Manager Relationships
Magic Bus
Room No. 5 (2nd Floor), A Wing, Todi Estate
Sun Mills Compound
Lower Parel (W)
Mumbai 400013
E-mail:
Tel: +91-9820523818 / Rekha Dey
Senior Manager Advocacy
Magic Bus
C-3/139, Sector 36
NOIDA 201301
E-mail:
Tel: +91-9811931122
http://www.magicbusindia.org
MAIDAN SUMMIT COMMITTEE
Chair - Alka Sesha
Convenor - Vivek Ramchandani
Project Management - Sheetal Satam and Rekha Dey
Communication and Corporate Relationship - Sohan Shah
Planning and Logistics - Azeem Rajwani

todi estate. room no. 5. a wing. 2nd floor. sun mills compound. lower parel (w). mumbai - 400 013
t: +91 22 2495 5149. +91 22 4333 9393 f: +91 22 4333 9394
e: w: www.magicbusindia.org