Project / Innovation Registration Form

(Please email the form to DICE2012@uettaxila.edu.pk)

Distinguished Innovations, Collaboration & Entrepreneurship

DICE Exhibition 2012
Project No (to be filled in by DICE 2012 admin):____________________
Innovation Title: ___________________________________________________________
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Brief Innovation
Description:__________________________________________________

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Participant names:
1. __________________ (Team Leader) Email address (required):_______________
2. __________________
3. __________________
4. __________________
5. _________________________________(Industry member with name of the company)
Academic Institution:
Name:
Address:
Corresponding Faculty Member:
Phone:
Email Address:
Head of Department:
Email Address:

______________________________
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______________________________
______________________________
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Domain (Tick One):

1. Agricultural & Veterinary Sciences

2. Arts & Humanities

3. Biological & Medical Sciences

4. Business Education

5. Engineering & Technology

6. Physical Sciences

7. Social Sciences

8. Other (specify)

Discipline within the Domain: ____________________

Hardware Requirement (For outstation students only)
1.
2.
(Dont fill this section if you are arranging your own)

Accommodation Required: YES

NO