Saturday, March 17, 2007
Sunday, March 11, 2007
Registration form
LANA
SAHITHYA SIBIRAM 2007
REGISTRATION FORM
Name in full---------------------------------------- Pen name(if any)------------------
Home address ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Telephone # (H)----------------------------------Office/Cell-----------------------------------
E-mail------------------------------------------------------------------------------------------
Number of attendees…….
Additional information(One or two sentence about you)---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Registration fee paid ($ 100/- per person)………………………………………….U.S.$ 100 -00
Additional ……………………………………………………………………………….
Total $..................................
(Please make cheque payable to Vasudev Pulickal for LANA. Cheque #..............................................
Please send your completed registration form and cheque to:
Vasudev Pulical,
8 Harcourt Road,
Plainview, N.Y. 11803
Contact tel. # Peter Neendoor (H) 914-423-9885, cell 914-434-2622
Vasudev Pulickal 516-932-9863, J.Mathews 914-693-6337, Prince Markose 516-489-7403.
Date…../…../……. Signature
Comments by LANA officials…………………………………………………………………..
…………………………………………………………………………………………………….
…………………………………………………………………………………………………………..
For hotel booking call : Floral Park Motor Lodge (Hot line 1-800-255-9680/ 516-775-7777)
Book the rooms on the name of LANA
Name in full---------------------------------------- Pen name(if any)------------------
Home address ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Telephone # (H)----------------------------------Office/Cell-----------------------------------
E-mail------------------------------------------------------------------------------------------
Number of attendees…….
Additional information(One or two sentence about you)---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Registration fee paid ($ 100/- per person)………………………………………….U.S.$ 100 -00
Additional ……………………………………………………………………………….
Total $..................................
(Please make cheque payable to Vasudev Pulickal for LANA. Cheque #..............................................
Please send your completed registration form and cheque to:
Vasudev Pulical,
8 Harcourt Road,
Plainview, N.Y. 11803
Contact tel. # Peter Neendoor (H) 914-423-9885, cell 914-434-2622
Vasudev Pulickal 516-932-9863, J.Mathews 914-693-6337, Prince Markose 516-489-7403.
Date…../…../……. Signature
Comments by LANA officials…………………………………………………………………..
…………………………………………………………………………………………………….
…………………………………………………………………………………………………………..
For hotel booking call : Floral Park Motor Lodge (Hot line 1-800-255-9680/ 516-775-7777)
Book the rooms on the name of LANA
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