JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Learning Circles 1 & 2 Registration Form
Application Form
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
State & Country
*
Your answer
PERSONAL INFORMATION
*
Dr.
Ms.
Mrs.
Mr.
Name (as on Certificate)
*
Your answer
Address
*
Your answer
Contact No.
*
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Languages Spoken
*
Your answer
Languages Written
*
Your answer
Current Job Description
*
Your answer
Institution & Department
*
Your answer
Educational Qualification (Year, University/College, Grade, Percentage)
*
Your answer
Duration
19 June to 18 July 2021 (LC 1)
Eligibility for LC 2 - Successful Completion of LC 1
26 June to 25 July 2021 (LC 2)
Fees
For members: LC 1: 4000/-
LC 2: 4000/-
LC 1 & 2: 7500/-
For non-members: LC 1: 5000
LC 2: 5000/-
LC 1 & 2= 9500/-
Registering for:
*
Choose
Learning Circle 1: Dyslexia: Screening and Identification
Learning Circle 1 & 2 : Dyslexia: Screening and Identification, Dyslexia: Classroom Strategies
The Following are the NEFT details for bank transfer (Only INR)
MAHARASHTRA DYSLEXIA ASSOCIATION
IDBI BANK
SUNNY ESTATE II
CHEMBUR, MUMBAI 400071
A/C NO.: 018104000075457 - Saving Account
IFSC CODE: IBKL0000018
SWIFT CODE – IBKLINBB004
PLEASE EMAIL THE PAYMENT DETAILS TO -
mda@dyslexiaindia.com
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
