Registrationform ICECIT

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Registration Form

ICECIT-2012
(International Conference on Emerging Trends in Electrical, Communication and Information Technologies)

(Please complete the registration form, scan it and email it to icecit2012@srit.ac.in)


(Each author of the paper should register separately)

Participant: Prof/Dr/Mr. /Ms. /Mrs. _____________________________________________


Address

______________________________________________
______________________________________________

Mob

: __________________ E-mail: _______________________________________

Paper Id (for authors):


Registration Type

______________________________________________
Registration Fee

(Tick whichever is applicable)

] Student

Rs. 1,000/-

] Academician

Rs. 3,000/-

] Industry

Rs. 4,000/-

] Overseas

$ 100

] Participant (Without paper)

Rs. 3,000/-

Accommodation Required:

Yes [

]/ No [

Fee Payment details: DD[ ] / Wire Transfer [ ](Tick the appropriate one)
Transaction Id / DD No :
Bank Name
:
Date
:
Amount
:

_________________________________________________
_________________________________________________
_________________________________________________
_________________________________________________

Name & Signature of the Author

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