Registration Form
Vision Impact Outdoor Photography Workshop
& Tour
MAKS, House#519/A (3rd
Floor), Road#1, Dhanmondi R/A, Dhaka-1205
Tel: 0188-40708, 01717-467665
E-mail:bayazidakter@gmail.com
Web site http://visionimpact06.tripod.com
1. Name..................................................................................................................................................
2. Gender.................... (M ) ....................
( F ) ....................
3. Father’s Name : ..................................................................................................................................
4. Mother’s Name : ..................................................................................................................................
5. Present Address: .................................................................................................................................
..............................................................................................................................................................
6. Permanent Address : ............................................................................................................................
..............................................................................................................................................................
..............................................................................................................................................................
7. Telephone Number:
Mobile : .................................................,
(Res./Off) ...............................................
8. Educational Qualifications:
.....................................................................................................................
9. Photographic Qualifications: (Basic) ..........................................(Self
learn)....................................... etc.
10. Date of Birth (D/M/Y): .................../..................../........................
11. Nationality..........................................................
12. Proposed Workshop
& Tour ............ Savar national memorial & surrounding area in 16th June, 2006
13. Workshop
& Tour Fees..................... Tk. 600/- (Six hundred) only. (Including breakfast, lunch, transportations, workshop
& tour fees)
Declaration: I will
be obliged to abide by the rules & regulations of Vision Impact. In addition to that I will be responsible for any unexpected
incident.
Signature of Candidate Signature of Coordinator
