Registration

Name: Prof./Dr./Mr./Ms

Designation:

Course Details (If, student)

Organization/Affiliation:

UniversityNGOCollege

Age:

Sex:

MaleFemale

Area:

Specialization (Subject):

Postal Address:

Mobile No.

Landline No.:

Primary eMail (Compulsory):

Alternate eMail (if available):

Are you submitting abstract in this symposium?

YesNo

Assistance for booking accommodation required?

YesNo

Early/Standard Registration:

Early Delegate Registration Rs. 4000/-Standard Student Registration Rs. 3000/- Late Registration: (After 15th January, 2016, 1st January, 2016)Late Delegate Registration Rs. 5000/-Late Student Registration Rs. 4000/-Cash (if registration form handed over in person)Cheque / Demand Draft (DD)

SECTION 1: REGISTRATION DETAILS

Name: Prof./Dr./Mr./Ms

Designation:

Course Details (If, student)

Organization/Affiliation:

Age:

Sex:

Area:

Specialization (Subject):

Postal Address:

Mobile No.

Landline No.:

Primary eMail (Compulsory):

Alternate eMail (if available):

Are you submitting abstract in this symposium?

Assistance for booking accommodation required?

SECTION 2: PAYMENT DETAILS

Please tick one Type of Registration

Early/Standard Registration:

Make an Enquiry

Register

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