Orientation Program for the Psychologists

On 26.11.2009 (Thursday)

(Including PG II year students of Psychology, Applied Psychology).

Ali Yavar Jung National Institute for the Hearing Handicapped,

Eastern Regional Center, NIOH Campus, B.T.Road, Bonhooghly,

Kolkata 700 090.

Last date of receiving participation form..20.11. 09.: 20.11.09

Name of the Participant (Age/Sex):

____________ _________ _________ ____________ _________ _________ _________

Educational Qualification:

____________ _________ _________ ____________ _________ _________ _________

Name & Address of the Institute/Center/ Office she is working/attached/ studying:

____________ _________ _________ ____________ _________ _________ _________

Recommendation of the Head of the Institute/Center/ Office/ with office stamp.

Preference of food: Vegetarian/Non- vegetarian. ____________ _________ ___

Signature of the participant.

Contact: Mr. Sudip Basu, Psychologist,

E-mail: kudipbasu@hotmail.com