Seminar Course – Psychoeducational Training Program (PETP)

Date

Title^*

Please SelectMr.Ms.Dr.Others

First Name^*

Surname^*

Designation^*

Educational Qualification^*

Professional Qualification^*

Mobile Number^*

Email^*

Address^*

Experience (In Years)^*

Have you attended any ICTRC program in the Past?

YesNo

Organization Name^*

Website^*

Nature of Employment^*

How did you come to know about the course?^*

Where is your current postal address (where communications from the institute would be sent)?^*

IndiaOutside Indian Territory

How many seminar courses are you applying for?

One Seminar Course (You can select any three PETP from the list below)Two Seminar Courses (You will be attending all six PETP mentioned below)

Seminar Courses

Total Amount Payable