REGISTRATION FORM

School of Chemical Sciences, NMU, Jalgaon

Celebration of
INTERNATIONAL YEAR OF CHEMISTRY 2011
WORKSHOP ON
PROJECT, THESIS AND PAPER WRITING IN CHEMISTRY

On 9th March 2012

Name: Prof. /Dr. /Mr. / Mrs. _______________________________________________
Designation: _____________________________________________________________
Address: _________________________________________________________________
_________________________________________________________________________
Phone No. _______________________________ Mobile No. _____________________
E- Mail: _________________________________ Fax: ___________________________
Registration Category: (Please tick appropriately)
PG Students (M. Sc. / M. Tech)

Research Students (M. Phil / Ph. D.)

Teachers
Details of Registration Fee:
DD No.: ______________________________

Amount: _____________________

Bank:

Date:

______________________________

____________________

Signature of Participant
Forwarded through,
Prof. /Dr. /Mr. / Mrs. _________________________________________________________ is
a bonafide student/ faculty of our college/ institute/ school/ Department.

Signature and Seal

Principal/ Director/ Head