PKI Outreach Programme (POP)

ONE-DAY SYMPOSIUM REGISTRATION FORM

PKI Outreach Programme
Please print and return by e-mail, regular mail or fax.

Date: 19 August 2010

Time: 09:00 A.M. to 05:00 P.M

Venue: Hotel Abad Plaza, Cochin

Information of Participant

Name:________________________________________________________________

Gender:  Male  Female

Designation: ___________________________________________________________

Organisation:___________________________________________________________

Address:_______________________________________________________________

City:________________________________ Postal code:________________________

Telephone:_____________________________Mobile:__________________________

Fax:_____________________________ E-mail:_______________________________

Registration Fee & Payment details

Fee includes admission to Symposium sessions, lunch, Symposium Kit.

Symposium fee : Rs 500/- per participant

No registration fee is payable for the nominations from Government Departments

Mode of Payment:
Rs_______________  Cash  Cheque: No________  Demand Draft: No_________

Cheque / Demand Draft should be in favour of “CDAC”, payable at Bangalore (Only local Cheques
will be accepted)

Date: ____/____/_________ Signature:______________________________

CENTRE FOR DEVELOPMENT OF ADVANCED COMPUTING

#68, Electronics City, Bangalore - 560100
Tel: 080 28523300; Fax: 080 28522590; e-mail: pop@ncb.ernet.in
Website: http://www.cdacbangalore.in