Download as doc, pdf, or txt
Download as doc, pdf, or txt
You are on page 1of 2

International Science Congress Association

3
rd
International Science Congress (ISC-2013)
8th - 9th December2013
at
Karunya University, Coimatore, !amil "adu, India
Registration Form
"ame
#ender $ale %emale
&esignation''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''

"ame o( )rganisation''KA*U"+A U"I,-*SI!+
Address (or Corres.ondence/ &-0A*!$-"! )% 1I)I"%)*$A!ICS, KA*U"+A "A#A*
KA*U"+A U"I,-*SI!+ C)I$1A!)*--231113
Country / I"&IA
04one ()) '''''''''''''''''''(*) ''''''''''''''''($o5)6728339880
--mail /.rema5ioin(o:gmail5com
Status o( 0artici.ant/ &elegates ;Student;S.ouse ;)t4es/ S!U&-"!
0lease tic</
I intend to attend t4e congress and .resent a .a.er
)ral 0oster
"ame o( Section/ PHARMACEUTICAL SCIENCE
(0lease re(er sections in t4e 1roc4ure or at t4e =esite)
I intend to attend t4e congress ut =ill not .resent .a.er
Details of payment for Registration Fee
-lectronic $oney !rans(er t4roug4 1an<;"-%!;*!#S;>ire !rans(er; >estern Union ;0ay0al ;Cas4; C4e?ue; &&
"o5 1377793 &ated/26;11;2013Amount/ *s;10805
1an<er@s "ame/ !A$IA"A&U $-*CA"&IA- 1A"K I"&IA
ISCA %ello= $emers are eBem.ted (rom t4e registration (ees5 0lease =rite your ISCA %ello=
$emers4i. "o5 nil5
Accommodation
0lease tic<
I =is4 to get accommodation
I do not =is4 to avail accommodation .rovided y organiCers
0lease send com.leted (orm at/ 329, 0al4ar "agar, *A0!C, ,I0-*oad, Indore-382008 ($0) I"&IA
04one/ 61-931-2212100 $oile/ 61-6302232773
>esite/ ===5isca5in, ===5isca5co5in --mail/ con(erence :isca5in
0 * - $ " A ! D &
E0lease (ill e(ore "ame :!r"
STUDENT
Subject Area: PHARMACEUTICAL SCIENCE
0lace /<arunya nagar &ate/ 03;12;2013 Signature/
0lease send com.leted (orm at/ 329, 0al4ar "agar, *A0!C, ,I0-*oad, Indore-382008 ($0) I"&IA
04one/ 61-931-2212100 $oile/ 61-6302232773
>esite/ ===5isca5in, ===5isca5co5in --mail/ con(erence :isca5in

You might also like