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17th PG Convention Form1
17th PG Convention Form1
17th PG Convention Form1
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10
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Photo
Registration Form
IPS Membership No.
Personal Details (Please fill in capital letters only)
Name:
College Name:
State:
City:
Correspondence Address:
Designation:
Mobile No.
E-mail:
Category:
Accompanying Person:
Date:
Pin Code:
Registration Fees:Category
st
Spot Registration 1
Non-IPS member
Bank Details:
th
March 2015
June 2015
Delegates
Students
Accompanying Person
INR 4000/-
INR 4000/-
INR 4000/-
INR 5000/-
INR 5000/-
INR 5000/-
INR 5500/-
INR 5500/-
INR 5500/-
INR 5500/-
INR 5500/-
INR 5500/-
Axis Bank,
Account No. 914010040149221
IFSC Code: UTIB0001242
Account Name: 17 TH IPS PG CONVENTION, Nagpur.
(DD should be drawn in favour of account name)
Payment Details: Cash / Demand Draft No. / NEFT Reference No. :_____________
For Registration Contact: Dr. Neelam Pande: +91-9822931899, Dr. Anita Kahar: +91-9421805735
E-mail: pgcon2015reg@gmail.com
Duly filled Registration Form along with DD / Online Transfer Receipt to be sent to the Conference Secretariat, by
Registered Post / Courier.
Your registration will only be confirmed on the receipt of the Registration Form and the proof of payment.
PG student should attach a letter from HOD as a proof of belonging to that College / University.
Spot registration does not include gift.
Accompanying person registration includes lunch, dinner, banquet and entry to scientific sessions and trade.